title: 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.
abstract: OBJECTIVE
  Coronary artery bypass graft (CABG) surgery is the standard of care for revascularisation of patients with left main coronary artery disease (LMCAD). Recent studies have suggested that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) may provide comparable outcomes in selected patients with LMCAD without extensive CAD. We therefore designed a trial to investigate whether PCI with XIENCE cobalt-chromium everolimus-eluting stents (CoCr-EES) would result in non-inferior or superior clinical outcomes to CABG in selected patients with LMCAD.
  
  
  RESULTS
  The Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial is a prospective, open-label, multicentre, international study of 1,900 randomised subjects. Patients with significant LMCAD with a SYNTAX score ≤32 and local Heart Team consensus that the subject is appropriate for revascularisation by both PCI and CABG are consented and randomised 1:1 to undergo PCI using CoCr-EES or CABG. All patients undergo follow-up for five years. The primary endpoint is the three-year composite rate of death, stroke or myocardial infarction, assessed at a median follow-up of at least three years (with at least two-year follow-up in all patients), powered for sequential non-inferiority and superiority testing.
  
  
  CONCLUSIONS
  The EXCEL study will define the contemporary roles of CABG and PCI using XIENCE CoCr-EES in patients with LMCAD disease with low and intermediate SYNTAX scores.
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Arie Pieter
authors.initials: AP
authors.lastname: Kappetein
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Sabik
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: David P
authors.initials: DP
authors.lastname: Taggart
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Pocock
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Ori
authors.initials: O
authors.lastname: Ben-Yehuda
authors.forename: Gerrit-Anne
authors.initials: GA
authors.lastname: van Es
authors.forename: Charles A
authors.initials: CA
authors.lastname: Simonton
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000601:surgery*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage; D006801:Humans; D062645:Percutaneous Coronary Intervention; D012107:Research Design
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus