{"id":"c102e28a59d6","type":"article","url":"https://hartvaat.nl/2019/04/09/cabg-of-stenting-bij-hoofdstamlijden-bij-diabetes/","title":"CABG of stenting bij hoofdstamlijden bij diabetes","title_en":"Bypass Surgery or Stenting for Left Main Coronary Artery Disease in Patients With Diabetes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","perifeer-vaatlijden","soul-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2019.01.037","source_url":"https://doi.org/10.1016/j.jacc.2019.01.037","authors":["Milan Milojevic","Patrick W Serruys","Joseph F Sabik","David E Kandzari","Erick Schampaert","Ad J van Boven","Ferenc Horkay","Imre Ungi","Samer Mansour","Adrian P Banning","David P Taggart","Manel Sabaté","Anthony H Gershlick","Andrzej Bochenek","Jose Pomar","Nicholas J Lembo","Nicolas Noiseux","John D Puskas","Aaron Crowley","Ioanna Kosmidou","Roxana Mehran","Ori Ben-Yehuda","Philippe Généreux","Stuart J Pocock","Charles A Simonton","Gregg W Stone","Arie Pieter Kappetein"],"significance":7,"published":"2019-04-09","source_date":"2019-04-09","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This EXCEL subanalysis examined outcomes of CABG versus stenting for left main disease specifically in patients with diabetes, investigating whether diabetes modifies the relative benefit of surgical versus percutaneous revascularization.","created":"2026-07-03T10:27:52Z","updated":"2026-07-03T13:27:04Z","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":"Analyse naar CABG versus stenting bij linker-hoofdstamcoronairlijden specifiek bij diabetespatiënten. Diabetes als modificator van de revascularisatiekeuze.","abstract_original":"BACKGROUND: The randomized EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial reported a similar rate of the 3-year composite primary endpoint of death, myocardial infarction (MI), or stroke in patients with left main coronary artery disease (LMCAD) and site-assessed low or intermediate SYNTAX scores treated with percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG). Whether these results are consistent in high-risk patients with diabetes, who have fared relatively better with CABG in most prior trials, is unknown. OBJECTIVES: In this pre-specified subgroup analysis from the EXCEL trial, the authors sought to examine the effect of diabetes in patients with LMCAD treated with PCI versus CABG. METHODS: Patients (N = 1,905) with LMCAD and site-assessed low or intermediate CAD complexity (SYNTAX scores ≤32) were randomized 1:1 to PCI with everolimus-eluting stents versus CABG, stratified by the presence of diabetes. The primary endpoint was the rate of a composite of all-cause death, stroke, or MI at 3 years. Outcomes were examined in patients with (n = 554) and without (n = 1,350) diabetes. RESULTS: The 3-year composite primary endpoint was significantly higher in diabetic compared with nondiabetic patients (20.0% vs. 12.9%; p < 0.001). The rate of the 3-year primary endpoint was similar after treatment with PCI and CABG in diabetic patients (20.7% vs. 19.3%, respectively; hazard ratio: 1.03; 95% confidence interval: 0.71 to 1.50; p = 0.87) and nondiabetic patients (12.9% vs. 12.9%, respectively; hazard ratio: 0.98; 95% confidence interval: 0.73 to 1.32; p = 0.89). All-cause death at 3 years occurred in 13.6% of PCI and 9.0% of CABG patients (p = 0.046), although no significant interaction was present between diabetes status and treatment for all-cause death (p = 0.22) or other endpoints, including the 3-year primary endpoint (p = 0.82) or the major secondary endpoints of death, MI, or stroke at 30 days (p = 0.61) or death, MI, stroke, or ischemia-driven revascularization at 3 years (p = 0.65). CONCLUSIONS: In the EXCEL trial, the relative 30-day and 3-year outcomes of PCI with everolimus-eluting stents versus CABG were consistent in diabetic and nondiabetic patients with LMCAD and site-assessed low or intermediate SYNTAX scores.(Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)."}