Higher readmission rates after PCI versus CABG for left main coronary artery disease: EXCEL trial

In the EXCEL trial, 1,905 patients with LMCAD were randomized to percutaneous coronary intervention versus coronary artery bypass grafting.

The cumulative incidence of readmissions was analyzed with multivariable Anderson-Gill and joint frailty models to consider recurrent events and the competing risk of death. A time-adjusted Cox proportional hazards model determined the impact of readmission on subsequent mortality within 5-year follow-up.

The study led to the following findings:

• Within 5 years, 1,868 readmissions occurred in 45.2% of hospital survivors (2.2 ± 1.9 per patient with readmission[s], range 1-16), approximately one-half for cardiovascular causes and one-half for noncardiovascular causes (49.6% and 50.4%, respectively).
• One or more readmissions occurred in 48.6% of PCI patients versus 41.8% of CABG patients.
• After multivariable adjustment, PCI remained an independent predictor of readmission (adjusted HR: 1.22), along with female sex, comorbidities, and the extent of CAD.
• Readmission was independently associated with subsequent all-cause death, with interaction testing indicating a higher risk after PCI than CABG (adjusted HR: 5.72 vs adjusted HR: 2.72, respectively).

"PCI was an independent predictor of readmission and associated with a higher readmission rate than CABG," the study authors concluded.

Reference:

DOI: https://www.jacc.org/doi/10.1016/j.jacc.2024.01.012