Dorset Heart Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, UK.
University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.
Catheter Cardiovasc Interv. 2024 Jul;104(1):27-33. doi: 10.1002/ccd.31080. Epub 2024 May 20.
Excimer laser atherectomy (ELCA) is an established adjunctive technique to facilitate acute success in percutaneous coronary intervention (PCI). Despite this there are a lack of contemporary outcome data, particulary longer-term, forpatients treated with ELCA PCI.
To evaluate the contemporary use ofELCA in PCI, the frequency of periprocedural complications and the longer-term outcomes associated with ELCA PCI.
This was a retrospective study that included all patients undergoing PCI (with or without ELCA) between April 2005 and May 2021. Relevant features from all cases were downloaded from the patient record and matched to hospital data on mortality on November 22, 2022. Kaplan Meier curves were used to compare mortality between the ELCA PCI and non-ELCA PCI cohorts with a landmark at 1 year. Multivariable Cox regression was performed to assess whether ELCA PCI was independently associated with long-term mortality.
There were 21,256 patients in this analysis, of which 448 (2.1%) were treated with ELCA PCI. ELCA PCI was associated with a higher frequency of any periprocedural complication. Median follow-up was 2812 days (IQR, 1577-4245 days) with higher mortality in ELCA PCI (38.2% vs. 29.0%, p < 0.001). However, on multivariable analysis, ELCA PCI was not independently associated with long-term mortality. The TVR frequency in ELCA PCI was 16.7% but TVR was significantly higher for cases of in-stent restenosis (ISR) (29.5%).
Despite ELCA PCI being used in higher risk populations with complex coronary artery disease there was no long-term increased mortality associated with the use of this device. ELCA PCI for ISR is highly effective and safe although TVR in this cohort remains high in long-term follow-up.
准分子激光消蚀术（ELCA）是经皮冠状动脉介入治疗（PCI）中一种辅助技术，有助于提高即刻成功率。尽管如此，目前仍缺乏关于接受 ELCA PCI 治疗的患者的最新临床结果数据，特别是在长期随访方面。
评估 ELCA 在 PCI 中的当代应用、围术期并发症的发生频率以及与 ELCA PCI 相关的长期预后。
这是一项回顾性研究，纳入了 2005 年 4 月至 2021 年 5 月期间所有接受 PCI（伴或不伴 ELCA）的患者。从患者病历中下载所有病例的相关特征，并与 2022 年 11 月 22 日的医院死亡率数据相匹配。使用 Kaplan-Meier 曲线比较 ELCA PCI 与非 ELCA PCI 两组的死亡率，以 1 年为标志。多变量 Cox 回归分析评估 ELCA PCI 是否与长期死亡率独立相关。
本研究共纳入 21256 例患者，其中 448 例（2.1%）接受了 ELCA PCI。ELCA PCI 与更高的围术期并发症发生率相关。中位随访时间为 2812 天（IQR：1577-4245 天），ELCA PCI 组死亡率更高（38.2%比 29.0%，p<0.001）。然而，多变量分析显示，ELCA PCI 与长期死亡率无独立相关性。ELCA PCI 组的 TVR 发生率为 16.7%，但在支架内再狭窄（ISR）病例中，TVR 显著更高（29.5%）。
尽管 ELCA PCI 用于治疗具有复杂冠状动脉疾病的高危人群，但使用该设备并未导致长期死亡率增加。ELCA PCI 治疗 ISR 效果显著且安全，尽管在长期随访中该队列的 TVR 仍较高。
