Outpatient Versus Inpatient Percutaneous Coronary Intervention in Patients with Left Main Disease (From the EXCEL Trial).
Gaba P., Serruys PW., Karmpaliotis D., Lembo NJ., Banning AP., Zhang Z., Morice M-C., Kandzari DE., Gershlick AH., Ben-Yehuda O., Sabik JF., Kappetein AP., Stone GW.
Prior studies in patients with non-complex coronary artery disease (CAD) have demonstrated the safety of percutaneous coronary intervention (PCI) in the outpatient setting. We sought to examine the outcomes of outpatient PCI in patients with unprotected left main CAD (LMCAD). In the EXCEL trial, 1905 patients with LMCAD and site-assessed low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus coronary artery bypass grafting. The primary endpoint was major adverse cardiovascular events (MACE; the composite of death, stroke, or MI). In this sub-analysis, outcomes at 30 days and 5 years were analyzed according to whether PCI was performed in the outpatient versus inpatient setting. Among 948 patients with LMCAD assigned to PCI, 935 patients underwent PCI as their first procedure, including 100 (10.7%) performed in the outpatient setting. Patients who underwent outpatient compared with inpatient PCI were less likely to have experienced recent MI. Distal LM bifurcation disease involvement and SYNTAX scores were similar between the groups. Comparing outpatient to inpatient PCI, there were no significant differences in MACE at 30 days (4.0% versus 5.0% respectively, adjusted OR 0.52 95% CI 0.12-2.22; p=0.38) or 5 years (20.6% versus 22.1% respectively, adjusted OR 0.72, 95% CI 0.40-1.29; p=0.27). Similar results were observed in patients with distal LM bifurcation lesions. In conclusion, in the EXCEL trial, outpatient PCI of patients with LMCAD was not associated with an excess early or late hazard of MACE. These data suggest that outpatient PCI may be safely performed in select patients with LMCAD.