{"id":"84a75f476cf5","type":"article","url":"https://hartvaat.nl/2016/12/08/everolimus-eluting-stents-of-bypasschirurgie-bij-hoofdstamcoronairlijden-nejm-ex/","title":"Everolimus-eluting stents of bypasschirurgie bij hoofdstamcoronairlijden: NEJM EXCEL-trial","title_en":"Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1610227","source_url":"https://doi.org/10.1056/NEJMoa1610227","authors":["Gregg W Stone","Joseph F Sabik","Patrick W Serruys","Charles A Simonton","Philippe Généreux","John Puskas","David E Kandzari","Marie-Claude Morice","Nicholas Lembo","W Morris Brown","David P Taggart","Adrian Banning","Béla Merkely","Ferenc Horkay","Piet W Boonstra","Ad J van Boven","Imre Ungi","Gabor Bogáts","Samer Mansour","Nicolas Noiseux","Manel Sabaté","José Pomar","Mark Hickey","Anthony Gershlick","Pawel Buszman","Andrzej Bochenek","Erick Schampaert","Pierre Pagé","Ovidiu Dressler","Ioanna Kosmidou","Roxana Mehran","Stuart J Pocock","A Pieter Kappetein"],"significance":10,"published":"2016-12-08","source_date":"2016-12-08","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"The EXCEL trial compared everolimus-eluting stents with CABG in patients with left main coronary artery disease of low-to-intermediate complexity. PCI was noninferior to CABG for the composite of death, stroke, or MI at 3 years, establishing percutaneous intervention as a viable alternative in selected left main disease.","created":"2026-07-03T10:26:27Z","updated":"2026-07-03T13:25:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM EXCEL-trial die EES vergeleek met CABG bij linker-hoofdstamcoronairlijden. Samen met NOBLE bepalend voor de revascularisatiestrategie bij hoofdstamziekte.","abstract_original":"BACKGROUND: Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. METHODS: We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. RESULTS: At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P<0.001 for noninferiority, P=0.008 for superiority). The secondary end-point event of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years occurred in 23.1% of the patients in the PCI group and in 19.1% in the CABG group (P=0.01 for noninferiority, P=0.10 for superiority). CONCLUSIONS: In patients with left main coronary artery disease and low or intermediate SYNTAX scores by site assessment, PCI with everolimus-eluting stents was noninferior to CABG with respect to the rate of the composite end point of death, stroke, or myocardial infarction at 3 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776 .)."}