New Revelations Ignite the EXCEL Affair and Expose the Distortion of Science

Commentary: The fate of patients with left main coronary artery disease may be dictated by distorted science

“…In a clinical trial, a finding of a statistically significant higher mortality in 1 arm than the other should be strongly emphasized and included in the conclusion of the abstract and of the main article, which did not happen. 9 The heightened rate of noncardiovascular death associated to second-generation drug-eluting stent as seen in EXCEL trial, the Randomized Comparison of CABG and Everolimus-Eluting Stent Implantation in the Treatment of Patients with Multivessel Coronary Artery Disease (BEST) trial, 10 and others, 3 mainly related to cancer and infection, brings apprehension because these data have reappeared again in the International Study of Comparative Health Effectiveness With Medical and Invasive Approach (ISCHEMIA) and ISCHEMIA-Chronic Kidney Disease (ISCHEMIA-CKD) trials, where noncardiovascular deaths trended higher in invasive strategy versus the conservative. 11,12 Until these issues are addressed, the EXCEL trial has the potential to become an example of distrust as a distorted form of science, leaving…”