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

Cardiology for February 21st, 2020. This week, more on the Excel trial controversy. Good news about GI bleeding on oral

anticoagulants, changes in medical education, and revascularization. It's only been a few weeks but the Excel trial is back in the news.

Recall that Excel is an RCT comparing percutaneous coronary intervention, PCI

versus coronary bypass grafting, cabbage, inpatients

with left main disease.

Being very brief here in the recent five-year results paper, Excel authors concluded that PCI and cabbage performed similarly.

But a read of the data suggested otherwise.

So true, the composite primary endpoint at five years was indeed non-significantly different.

But the definition of MI, which was a key component of the primary endpoint clearly favored PCI.

Second, the overall death rate was 3.1% higher in absolute terms in the PCI arm

and the curves were separating by five years.

Third, a landmark analysis of early and late parts of the follow-up suggested a benefit

early for PCI, but this was driven by the controversial way in which peri procedural

...