EXCEL试验：外科医生的观点。
The EXCEL Trial: The Surgeons' Perspective.
作者信息
Jahangiri Marjan, Mani Krishna, Yates Martin T, Nowell Justin
机构信息
Department of Cardiac Surgery, St. George's Hospital London, UK.
出版信息
Eur Cardiol. 2020 Nov 9;15:e67. doi: 10.15420/ecr.2020.34. eCollection 2020 Feb.
Abstract
There have been several investigations comparing the efficacy of percutaneous coronary intervention and coronary artery bypass grafting surgery for treatment of left main stem disease. This includes the Evaluation of XIENCE versus Coronary Artery Bypass Graft Surgery for Effectiveness of Left Main Revascularizaton (EXCEL) trial, which has garnered significant controversy surrounding its experimental design and reporting of its results. The authors review the methodology, results, caveats and statements on the EXCEL trial. They also review the other trials in the management of left main stem disease comparing percutaneous coronary intervention with coronary artery bypass grafting, as well as the SYNTAX score and its role in future guidelines for revascularisation. These findings have significant implications for current practice, influencing the growing role for multidisciplinary team meeting and allowing clinicians and patients to make the right choice.
摘要
已有多项研究比较经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗左主干疾病的疗效。这包括“XIENCE与冠状动脉旁路移植术治疗左主干血运重建有效性的评估”（EXCEL）试验，该试验在其实验设计和结果报告方面引发了重大争议。作者回顾了EXCEL试验的方法、结果、注意事项和声明。他们还回顾了其他比较经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗左主干疾病的试验，以及SYNTAX评分及其在未来血运重建指南中的作用。这些发现对当前的临床实践具有重要意义，影响着多学科团队会议日益重要的作用，并使临床医生和患者能够做出正确的选择。
相似文献
1
The EXCEL Trial: The Surgeons' Perspective.EXCEL试验：外科医生的观点。
Eur Cardiol. 2020 Nov 9;15:e67. doi: 10.15420/ecr.2020.34. eCollection 2020 Feb.
2
Contemporary Outcomes Following Coronary Artery Bypass Graft Surgery for Left Main Disease.左主干病变行冠状动脉旁路移植术后的当代结局。
J Am Coll Cardiol. 2019 Apr 23;73(15):1877-1886. doi: 10.1016/j.jacc.2018.12.090.
3
Long-term forecasting and comparison of mortality in the Evaluation of the Xience Everolimus Eluting Stent vs. Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial: prospective validation of the SYNTAX Score II.EXCEL 试验中依维莫司洗脱支架与冠状动脉旁路移植术治疗左主干血运重建效果的长期预测和死亡率比较：SYNTAX 评分 II 的前瞻性验证。
Eur Heart J. 2015 May 21;36(20):1231-41. doi: 10.1093/eurheartj/ehu518. Epub 2015 Jan 12.
4
Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes.左主干病变伴糖尿病患者行旁路移植术或支架置入术治疗的比较
J Am Coll Cardiol. 2019 Apr 9;73(13):1616-1628. doi: 10.1016/j.jacc.2019.01.037.
5
Stroke Rates Following Surgical Versus Percutaneous Coronary Revascularization.冠状动脉血运重建术后卒率比较：外科手术与经皮冠状动脉介入治疗。
J Am Coll Cardiol. 2018 Jul 24;72(4):386-398. doi: 10.1016/j.jacc.2018.04.071.
6
Percutaneous Coronary Intervention of Left Main Disease: Pre- and Post-EXCEL (Evaluation of XIENCE Everolimus Eluting Stent Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic-Baltic-British Left Main Revascularization Study) Era.左主干疾病的经皮冠状动脉介入治疗：EXCEL（评价依维莫司洗脱支架 XIENCE 与冠状动脉旁路移植术治疗左主干血运重建效果）和 NOBLE（北欧-波罗的海-英国左主干血运重建研究）时代之前和之后。
Circ Cardiovasc Interv. 2017 Jun;10(6). doi: 10.1161/CIRCINTERVENTIONS.117.004792.
7
Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis.经皮冠状动脉介入治疗联合药物洗脱支架与冠状动脉旁路移植术治疗左主干冠状动脉疾病的比较：一项个体患者数据分析荟萃研究。
Lancet. 2021 Dec 18;398(10318):2247-2257. doi: 10.1016/S0140-6736(21)02334-5. Epub 2021 Nov 15.
8
Design and rationale for a randomised comparison of everolimus-eluting stents and coronary artery bypass graft surgery in selected patients with left main coronary artery disease: the EXCEL trial.依维莫司洗脱支架与冠状动脉旁路移植术在特定左主干冠状动脉疾病患者中的随机对照研究设计及原理：EXCEL试验
EuroIntervention. 2016 Sep 18;12(7):861-72. doi: 10.4244/EIJV12I7A141.
9
B-Type Natriuretic Peptide Assessment in Patients Undergoing Revascularization for Left Main Coronary Artery Disease: Analysis From the EXCEL Trial.B 型利钠肽评估在左主干冠状动脉疾病血运重建患者中的应用：来自 EXCEL 试验的分析。
Circulation. 2018 Jul 31;138(5):469-478. doi: 10.1161/CIRCULATIONAHA.118.033631.
10
Outcomes After Left Main Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting According to Lesion Site: Results From the EXCEL Trial.根据病变部位比较经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗左主干病变的结果：EXCEL 试验结果。
JACC Cardiovasc Interv. 2018 Jul 9;11(13):1224-1233. doi: 10.1016/j.jcin.2018.03.040.
引用本文的文献
1
Clinical Updates in Coronary Artery Disease: A Comprehensive Review.冠状动脉疾病的临床进展：全面综述
J Clin Med. 2024 Aug 6;13(16):4600. doi: 10.3390/jcm13164600.
2
Recent Evidence on Advances in PCI Treatment for Left Main Coronary Artery Disease.左主干冠状动脉疾病经皮冠状动脉介入治疗进展的最新证据
Rev Cardiovasc Med. 2022 Oct 31;23(11):370. doi: 10.31083/j.rcm2311370. eCollection 2022 Nov.
3
Coronary Artery Surgery: Past, Present, and Future.冠状动脉手术：过去、现在与未来。
Rambam Maimonides Med J. 2024 Jan 19;15(1):e0001. doi: 10.5041/RMMJ.10515.
4
Predicting Determinants for Conversion of Off-Pump Coronary Revascularization to On-Pump Surgery: A Retrospective Analysis.非体外循环冠状动脉血运重建转换为体外循环手术的预测因素：一项回顾性分析。
Cureus. 2023 Jul 21;15(7):e42258. doi: 10.7759/cureus.42258. eCollection 2023 Jul.
5
A Risk Score for Predicting Long-Term Mortality Following Off-Pump Coronary Artery Bypass Grafting.预测非体外循环冠状动脉旁路移植术后长期死亡率的风险评分
J Clin Med. 2021 Jul 7;10(14):3032. doi: 10.3390/jcm10143032.
本文引用的文献
1
The transfiguration of the EXCEL trial: exceeding ethical and moral boundaries.EXCEL 试验的变形：超越伦理和道德界限。
Eur J Cardiothorac Surg. 2020 Jul 1;58(1):30-34. doi: 10.1093/ejcts/ezaa121.
2
Effect of total arterial grafting in the Arterial Revascularization Trial.全动脉搭桥术在动脉血运重建试验中的效果。
J Thorac Cardiovasc Surg. 2022 Mar;163(3):1002-1009.e6. doi: 10.1016/j.jtcvs.2020.03.013. Epub 2020 Mar 19.
3
The role of fractional flow reserve in coronary artery bypass graft surgery: a meta-analysis.冠状动脉旁路移植手术中血流储备分数的作用：一项荟萃分析。
Interact Cardiovasc Thorac Surg. 2020 May 1;30(5):671-678. doi: 10.1093/icvts/ivaa006.
4
Mortality After Repeat Revascularization Following PCI or CABG for Left Main Disease: The EXCEL Trial.左主干病变经 PCI 或 CABG 重复血运重建后的死亡率：EXCEL 试验。
JACC Cardiovasc Interv. 2020 Feb 10;13(3):375-387. doi: 10.1016/j.jcin.2019.09.019. Epub 2020 Jan 15.
5
Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: updated 5-year outcomes from the randomised, non-inferiority NOBLE trial.经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗无保护左主干狭窄：NOBLE 随机非劣效性试验的 5 年更新结果。
Lancet. 2020 Jan 18;395(10219):191-199. doi: 10.1016/S0140-6736(19)32972-1. Epub 2019 Dec 23.
6
Five-Year Outcomes after PCI or CABG for Left Main Coronary Disease.左主干冠状动脉疾病经皮冠状动脉介入治疗或冠状动脉旁路移植术后 5 年的结果。
N Engl J Med. 2019 Nov 7;381(19):1820-1830. doi: 10.1056/NEJMoa1909406. Epub 2019 Sep 28.
7
Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial.经皮冠状动脉介入治疗与冠状动脉旁路移植术治疗三血管病变或左主干病变患者：多中心随机对照 SYNTAX 试验 10 年随访结果。
Lancet. 2019 Oct 12;394(10206):1325-1334. doi: 10.1016/S0140-6736(19)31997-X. Epub 2019 Sep 2.
8
Off-Pump Versus On-Pump Bypass Surgery for Left Main Coronary Artery Disease.非体外循环与体外循环旁路手术治疗左主干冠状动脉疾病。
J Am Coll Cardiol. 2019 Aug 13;74(6):729-740. doi: 10.1016/j.jacc.2019.05.063.
9
Noninferiority Designed Cardiovascular Trials in Highest-Impact Journals.高影响力期刊中的心血管非劣效性设计临床试验。
Circulation. 2019 Jul 30;140(5):379-389. doi: 10.1161/CIRCULATIONAHA.119.040214. Epub 2019 Jun 10.
10
'Ten commandments' for the 2018 ESC/EACTS Guidelines on Myocardial Revascularization.2018年欧洲心脏病学会/欧洲心胸外科学会心肌血运重建指南的“十诫”
Eur Heart J. 2019 Jan 7;40(2):79-80. doi: 10.1093/eurheartj/ehy855.
Zotero 插件