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Hi everyone, this is John Mandrola from the Heart.org Medscape Cardiology and this is this week in

cardiology for December 13th, 2019. This week will be a special show. I'll focus mostly on the Excel trial controversy and now contrast that with my experience at the FDA this week.

The controversy got started when the BBC News Night program that aired recently.

This reignited the debate over the Excel study.

Now recall that Excel was the RCT comparing PCI to

cabbage in left-main disease. New England Journal published three-year results of

this trial in 2016 and then five-year results this fall.

The conclusion of both these papers was equivalence of the two techniques.

Now that means that literally all patients who have left main disease are

going to choose PCI given that it's a much easier procedure to recover from.

However, a few weeks later after the fall presentation of the five-year

results of Excel, Dr David Taggard, a surgeon, and others presented strong

criticism of the trial interpretation during a session at the

European Association of Cardiothorastic Surgeons.

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