Excimer LASER coronary atherectomy for ST-segment elevation myocardial infarction: Insights from a multicenter
Yuji Matsuda1, Taishi Yonetsu1, Ken Kurihara2
1Department of Cardiovascular Medicine, Institute of Science Tokyo Hospital, Tokyo, Japan.
Insights
Excimer laser coronary atherectomy (ELCA) did not reduce adverse cardiac events in ST-segment elevation myocardial infarction (STEMI) patients. Larger ELCA catheters may offer better outcomes, suggesting a need for further research in STEMI treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Excimer laser coronary atherectomy (ELCA) is utilized for thrombotic lesions in ST-segment elevation myocardial infarction (STEMI).
- The clinical effectiveness of ELCA in STEMI patients remains incompletely understood.
Purpose of the Study:
- To evaluate the effectiveness of ELCA in patients with STEMI undergoing primary percutaneous coronary intervention.
- To compare clinical outcomes between patients treated with and without ELCA.
Main Methods:
- Retrospective analysis of consecutive STEMI patients within 24 hours of symptom onset.
- Patients were divided into ELCA and non-ELCA groups.
- Target vessel-related major adverse cardiac events (TV-MACE) were the primary endpoint, analyzed using Cox regression and propensity score matching.
Main Results:
- No significant difference in TV-MACE-free survival between ELCA and non-ELCA groups in the overall cohort (2593 patients).
- ELCA use was not a significant predictor of TV-MACE (HR 1.265, p=0.161).
- In propensity score-matched cohort (736 patients), TV-MACE-free survival remained similar between groups.
Conclusions:
- ELCA use is not associated with reduced adverse cardiac events in STEMI patients.
- A trend towards better outcomes was observed with large-sized ELCA catheters (1.4-1.7 mm), suggesting potential benefits.
- Further prospective studies are warranted to confirm the efficacy of large-sized ELCA catheters in STEMI.
Background:
Excimer laser coronary atherectomy (ELCA) is used for thrombotic culprit lesions in ST-segment elevation myocardial infarction (STEMI), but its effectiveness is still unclear.
Methods:
Consecutive patients undergoing primary percutaneous coronary intervention within 24 h of onset were retrospectively investigated. Patients were divided into ELCA and non-ELCA groups. The primary endpoint was target vessel-related major adverse cardiac events (TV-MACE). Cox regression analysis and propensity score matching were performed to compare clinical outcomes between the two groups.
Results:
A total of 2593 patients were included in the analysis, with a median follow-up of 815 (390-1385) days. In the total cohort, there was no significant difference between the two groups in terms of TV-MACE-free survival rate. ELCA use was not a significant determinant of TV-MACE (hazard ratio 1.265, 95 % confidence interval, 0.910-1.757; p = 0.161). Nevertheless, when the ELCA group was stratified by the ELCA catheter size, the large catheter (1.4 mm-1.7 mm) group showed a lower event rate compared to the others in univariate analysis, although this difference was not significant in multivariate analysis. In the propensity score-matched cohort of 736 patients (368 pairs), the TV-MACE-free survival did not differ between the two groups.
Conclusions:
ELCA use was not associated with a reduced rate of adverse cardiac events in patients with STEMI. However, the use of large-sized ELCA catheters showed a potential association with better clinical outcomes, warranting further prospective studies.
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