Excimer LASER coronary atherectomy for ST-segment elevation myocardial infarction: a multicenter retrospective cohort analysis

BACKGROUNDExcimer laser coronary atherectomy (ELCA) is used for thrombotic culprit lesions in ST-segment elevation myocardial infarction (STEMI), but its efficacy is still unclear. The study objective was to investigate the clinical outcomes of STEMI patients after ELCA. METHODSData of consecutive patients undergoing primary percutaneous coronary intervention (PCI) within 24 hours of onset, in 12 healthcare facilities in Japan, were retrospectively analyzed. 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 adjust for selection bias in the cohort. RESULTSA total of 2593 patients, which included 427 patients treated with ELCA, were analyzed with a median follow-up of 815 (390-1385) days. 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 [HR] 1.265, 95% confidence interval [CI], 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 better clinical outcomes than the others in univariate Cox regression analysis (HR 0.30, 95% CI 0.10-0.95, p=0.040). In the propensity score-matched cohort of 736 patients (368 pairs), the TV-MACE-free survival did not differ between the two groups. CONCLUSIONSELCA did not show clinical benefit in terms of the rate of adverse cardiac events in patients with STEMI. There was evidence of efficacy when a large ELCA catheter was used, warranting further prospective studies. Clinical PerspectiveO_ST_ABSWhat is new?C_ST_ABSO_LIIn a relatively large-scale registry of STEMI patients undergoing primary PCI, which included 427 patients treated with ELCA, the use of ELCA did not show clinical benefits in reducing target-vessel related adverse events. C_LIO_LIThe use of ELCA was not associated with improved coronary flow or myocardial perfusion, but rather with higher peak values of cardiac markers. C_LIO_LILarger ELCA catheters ([≥]1.4mm diameter) may be associated with better clinical outcomes compared to smaller (0.9mm) ELCA catheters, suggesting potential areas for future research. C_LI What are the clinical implications?O_LIThe routine use of ELCA may not reduce adverse cardiac events in primary PCI for patients with STEMI. C_LIO_LIThe use of ELCA should be limited to lesions where large-sized ELCA catheters can be safely applied. C_LI