Efficacy and safety of excimer laser atherectomy in coronary intervention for acute myocardial infarction

XU Liang; NIU Si-quan; WANG Di; XIN Peng-cheng; NING Hong-jie; QIAO Mu

doi:10.13820/j.cnki.gdyx.20240530

Abstract：Objective To explore the efficacy and safety of excimer laser atherectomy(ELCA)in coronary inter-vention for acute myocardial infarction(AMI).Methods A total of 97 patients with AMI who received coronary inter-vention at Zhengzhou Seventh People's Hospital from April 2021 to September 2022 were selected.The patients were ran-domly divided into two groups using envelope randomization.The control group(n=49)received conventional balloon an-gioplasty combined with drug-eluting stent(DES)implantation,while the study group(n=48)received the same treat-ment with the addition of excimer laser coronary atherectomy(ELCA).The two groups were compared in terms of infarct vessel location,TIMI flow grade,pre-and post-procedural residual stenosis,intravascular ultrasound(IVUS)parame-ters,surgical indicators,and the occurrence of safety endpoint events.Results There were no significant differences be-tween the groups in terms of preoperative lumen stenosis(P>0.05)and infarct vessel location(P>0.05).Postopera-tively,lumen stenosis improved in both groups,but the study group had a significantly lower degree of stenosis than the control group,with a greater improvement in TIMI flow grade(P<0.05).There were no significant differences in IVUS parameters between the two groups(P>0.05).Preoperatively,there were no differences between the groups in levels of hs-cTnI,CK-MB,or NT-proBNP(P>0.05),but 8 weeks postoperatively,all biomarkers decreased significantly in both groups,with the study group showing lower levels than the control group(P<0.05).The two groups showed no sig-nificant differences in contrast agent dose,balloon post-dilatation,average stent length,or stent diameter(P>0.05).The study group had a longer procedural time and fewer balloon pre-dilatation attempts compared to the control group(P<0.05).During the one-year follow-up,the study group had 1 case of coronary dissection,3 cases of no reflow,and 4 cases of acute occlusion of collateral vessels,with an overall safety event rate of 16.33%(8/49).The control group had 2 cases of coronary dissection,4 cases of no reflow,and a total safety event rate of 12.50%(6/48),with no signifi-cant difference between the groups(x2=0.287,P>0.05).Conclusion Excimer laser atherectomy in coronary inter-vention for acute myocardial infarction demonstrates good efficacy and relatively favorable safety.It significantly improves vascular stenosis and reduces myocardial injury,making it an effective adjunctive treatment method.