Effectiveness of excimer laser coronary angioplasty in acute myocardial infarction or in unstable angina pectoris

Abstract

This study was conducted to evaluate the feasibility, safety, and acute results of percutaneous excimer laser coronary angioplasty (ELCA) in acute coronary syndromes. Fifty-nine patients were treated with ELCA (308 nm), including 33 patients with unstable angina pectoris (UAP) (35 vessels with 39 lesions) and 26 patients with acute myocardial infarction (AMI) (26 vessels with 29 lesions). In each patient the target lesion had a complex morphology. Overall, 71% of the patients had contraindications for pharmacologic thrombolytic agents or glycoprotein IIb/IIIa receptor antagonists. All patients received adjunct balloon dilation followed by stent implantation in 88% of patients with AMI versus 76% of patients with UAP (p = NS). Quantitative angiography was performed at an independent core laboratory; 86% laser success and 100% procedural success was achieved in the AMI group versus 87% laser success and 97% procedural success in the UAP group (p = NS). In the AMI group, the minimal luminal diameter increased from 0.77 ± 0.56 to 1.44 ± 0.47 mm after lasing to a final 2.65 ± 0.47 mm versus 0.77 ± 0.38 to 1.35 ± 0.4 mm after lasing to 2.66 ± 0.5 mm final in the UAP group. A prelaser percent stenosis of 76 ± 17% for the AMI group versus 70 ± 16% for the UAP group (p = NS) was decreased after lasing to 52 ± 16% for the AMI group versus 51 ± 14% for the UAP group (p = NS) and to a final stenosis of 15 ± 17% for the AMI group versus 12 ± 15% for the UAP group (p = NS). A 96% laser-induced reduction of thrombus burden area was achieved in the AMI group versus 97% in the UAP group (p = NS). Preprocedure Thrombolysis In Myocardial Infarction flow of 1.3 ± 0.9 in the AMI group versus 2.3 ± 1.2 for the UAP group (p = 0.01) increased to a final flow of 3.0 ± 0 for the AMI group versus 3.0 ± 0 for the UAP group (p = NS). There were no deaths, cerebrovascular accident, emergency bypass surgery, acute closure, major perforation or major dissection, distal embolization, or bleeding complications in either group. One patient with AMI had localized perforation (caused by guidewire) without sequelae and 1 patient with UAP had an abnormal increase in creatine kinase levels. All 59 patients survived the laser procedure, improved clinically, and were discharged. Thus, early experience in patients with acute coronary syndromes suggest that percutaneous ELCA is feasible and safe.