Excimer laser coronary atherectomy (ELCA) is a recognized adjunctive therapy utilized in the percutaneous management of complex coronary lesions. Studies examining its safety and utility have been limited by small sample sizes. Our study examines the determinants and outcomes of ELCA.

Methods

Using the British Cardiac Intervention Society database, data were analyzed on all PCI procedures in the UK between 2006–2016. Descriptive statistics and multivariate logistic regressions were used to examine baseline, procedural and outcome associations with ELCA.

Results

We identified 1,471 (0.21%) ELCA cases out of 686,358 PCI procedures. Baseline covariates associated with ELCA use were age, BMI, number of lesions, CTO or restenosis attempted and history of prior MI, CABG or PCI. Procedural co-variates associated with ELCA were the use of glycoprotein inhibitors, intravascular imaging, rotational atherectomy, cutting balloons, microcatheters and intra-aortic balloon pumps. Adjusted rates of in-hospital major adverse cardiac/cerebrovascular events (MACCE) or its individual components (death, peri-procedural MI, stroke and major bleed) were not significantly altered by the use of ELCA. However, there were higher odds of dissection (OR 1.52, 95% CI 1.17–1.98), perforation (OR 2.18, 95% CI 1.44–3.30), slow flow (OR: 1.67, 95% CI 1.18–2.36), reintervention (OR: 2.12, 95% CI 1.14–3.93) and arterial complications (OR: 1.63, 95% CI 1.21–2.21).

Conclusions

ELCA use during complex PCI is associated with higher risk baseline and procedural characteristics. Although increased rates of acute procedural complications were observed, ELCA does not increase likelihood of in-hospital MACCE or its individual components.

CONFLICTS OF INTEREST

There are no conflicts of interest for any authors relevant to this work.

Supporting Information

Filename	Description
ccd29251-sup-0001-FigureS1.tifTIFF image, 166.4 KB	Supplementary Figure S1 Consort flow diagram for study population
ccd29251-sup-0002-FigureS2.tifTIFF image, 339.5 KB	Supplementary Figure S2 Histogram of cumulative operator volume distribution for ELCA procedures 2013–2016. Operator volume over the study period was divided into quartiles of equal procedure numbers. There were a total of 92 ELCA operators during this period with the following quartile (Q) divisions: Q1: 1–7 procedures, Q2: 7–16 procedures, Q3: 16–35 procedures and Q4: 35–68 procedures.
ccd29251-sup-0003-FigureS3.tifTIFF image, 560.4 KB	Supplementary Figure S3 Multivariate Logistic Regression for ELCA use by baseline comorbidity in patients undergoing PCI in England and Wales 2006–2016. CI: confidence interval.
ccd29251-sup-0004-TableS1.docxWord 2007 document , 13.4 KB	Supplementary Table S1 Percentage of missing data in baseline, procedural and outcome variables
ccd29251-sup-0005-TableS2.docxWord 2007 document , 13.5 KB	Supplementary Table S2 Procedural variables by ELCA use in patients undergoing PCI in England and Wales 2006–2016. SD: standard deviation. CTO: chronic total occlusion.
ccd29251-sup-0006-TableS4.docxWord 2007 document , 13.5 KB	Supplementary Table S3 Crude outcomes by ELCA use in patients undergoing PCI in England and Wales 2006–2016.
ccd29251-sup-0007-TableS5.docxWord 2007 document , 14.1 KB	Supplementary Table S4 Outcomes by use of intravascular imaging in patients undergoing ELCA-PCI in England and Wales 2006–2016. In this model, only cases that utilized ELCA were included and were stratified by use of imaging (vs not). Model was adjusted for age, gender, BMI, number of vessels/lesions/CTO/restenosis attempted, number/length of stents used, number of lesions successful, length of hospital stay, cardiogenic shock, Prior MI/PCI/CABG/stroke, valve disease, renal disease, diabetes mellitus, EF <30%, LMS/LAD/RCA/Cx stenosis, smoking and family history, hypertension, peripheral vascular disease, femoral/dual access, GPIIBIIIA inhibitors, use of pressure wires, rotational atherectomy, cutting balloons, microcatheters or IABP. CI: confidence interval, MACCE: Major adverse cardiac and cerebrovascular events

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Citing Literature

Volume97, Issue5

April 1, 2021

Pages E653-E660

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Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database

Abstract

Introduction

Methods

Results

Conclusions

CONFLICTS OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Information

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Excimer laser coronary atherectomy during complex PCI: An analysis of 1,471 laser cases from the British Cardiovascular Intervention Society database

Abstract

Introduction

Methods

Results

Conclusions

CONFLICTS OF INTEREST

Supporting Information

REFERENCES

Citing Literature

References

Related

Information