EXCEL, SYNTAXES Analyses Spotlight Periprocedural MI Controversy

Investigators from the EXCEL trial have doubled down on the July publication of their study’s outcomes based on an alternative definition of myocardial infarction (MI) resulting from coronary revascularization, a key part of the controversy that has dogged EXCEL for a year or more.

The latest, more granular EXCEL analysis pits periprocedural MI (PMI), as defined in the trial’s protocol, against PMI according to the more stringent third Universal Definition Of Myocardial Infarction (UDMI). The stakes for EXCEL’s message are high because PMI is part of the composite primary end point.

The new analysis concludes with a preference for interpreting EXCEL — which compared percutaneous coronary revascularization (PCI) and coronary artery bypass (CABG) surgery in patients with left-main coronary artery disease (LMCAD) — using the protocol-specified PMI definition, which was based solely on levels of CK-MB (and sometimes troponin), rather than the UDMI. That alternative definition adds clinical signs, electrocardiography

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