Excimer LASER coronary atherectomy for ST-segment elevation myocardial infarction: Insights from a multicenter registry

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.