Efficacy and Safety of Excimer Laser Coronary Atherectomy in Acute Coronary Syndrome: Real-World Evidence From a Propensity-Adjusted Analysis
ABSTRACT
Background
The clinical effectiveness of excimer laser coronary atherectomy (ELCA) in acute coronary syndrome (ACS) remains uncertain due to limited evidence from prior studies.
Aims
To evaluate the clinical characteristics of patients who underwent primary PCI with ELCA in the setting of ACS, and to asses the impact of ELCA on clinical outcomes.
Methods
This retrospective study included 586 consecutive ACS patients who underwent primary PCI, stratified by ELCA use (ELCA-group, n = 256; non-ELCA group, n = 330). Propensity score matching was performed to compare clinical outcomes between the groups. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, nonfatal myocardial infarction, and target lesion revascularization (TLR). Subgroup analysis was conducted to identify factors associated with the efficacy of ELCA.
Results
Patients in the ELCA group were younger, more often presented with STEMI, had lower initial TIMI flow grades, and exhibited a higher thrombus burden with less calcification compared to the non-ELCA group. After propensity score matching, baseline characteristics were well balanced. MACE occurred in 6% of the ELCA group and 15% of the non-ELCA group (p = 0.001), with this difference remaining significant after matching (p = 0.001). The difference in MACE was primarily driven by the rate of TLR (3% vs. 10%, p < 0.001), which also remained significant after matching (p < 0.001). Slow flow occurred in 26% of the ELCA group and 19% of the non-ELCA group; however, the difference disappeared after matching (p = 0.526). Rates of perforation and distal embolization were low, with no significant difference between groups. Subgroup analysis revealed that initial high TIMI flow grade (TIMI 2 or 3), diabetes mellitus (DM), and hypertension were significantly associated with improved outcomes from ELCA.
Conclusion
In ACS, ELCA was selectively performed in those with specific clinical and lesion characteristics and was associated with reduced MACE in real-world practice. Subgroup analysis suggested that patients with initial high TIMI flow grade, DM, and hypertension might derive greater benefits from ELCA. These findings highlight the importance of lesion selection in optimizing the safety and effectiveness of ELCA in ACS.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The authors have nothing to report.
