OBJECTIVES: The aim of this study is to verify the study hypothesis of the EXCEL 
trial by comparing percutaneous coronary intervention (PCI) and coronary artery 
bypass graft (CABG) in an EXCEL-like population of patients.
BACKGROUND: The upcoming EXCEL trial will test the hypothesis that left main 
patients with SYNTAX score ≤ 32 experience similar rates of 3-year death, 
myocardial infarction (MI), or cerebrovascular accidents (CVA) following 
revascularization by PCI or CABG.
METHODS: We compared the 3-year rates of death/MI/CVA and death/MI/CVA/target 
vessel revascularization (MACCE) in 556 patients with left main disease and 
SYNTAX score ≤ 32 undergoing PCI (n = 285) or CABG (n = 271). To account for 
confounders, outcome parameters underwent extensive statistical adjustment.
RESULTS: The unadjusted incidence of death/MI/CVA was similar between PCI and 
CABG (12.7% vs. 8.4%, P = 0.892), while MACCE were higher in the PCI group 
compared to the CABG group (27.0% vs. 11.8%, P < 0.001). After propensity score 
matching, PCI was not associated with a significant increase in the rate of 
death/MI/CVA (11.8% vs. 10.7%, P = 0.948), while MACCE were more frequently 
noted among patients treated with PCI (28.8% vs. 14.1%, P = 0.002). Adjustment 
by means of SYNTAX score and EUROSCORE, covariates with and without propensity 
score, and propensity score alone did not change significantly these findings.
CONCLUSIONS: In an EXCEL-like cohort of patients with left main disease, there 
seems to be a clinical equipoise between PCI and CABG in terms of death/MI/CVA. 
However, even in patients with SYNTAX score ≤ 32, CABG is superior to PCI when 
target vessel revascularization is included in the combined endpoint.