The Application Of Excimer Laser Coronary Atherectomy In STEMI During Primary Percutaneous Coronary Intervention

ObjectiveResults for primary percutaneous coronary intervention in acute ST-segment elevation myocardial infarction(STEMI)have been limited in part by slow/no reflow,distal embolization and other complications which seriously affect the prognosis.a process which might be reduced by the application of ELCA.The aim was to evaluate the feasibility and safety of ELCA in STEMI during PCI.MethodsThis article retrospected 25 patients with Rich-thrombus lesions in the General Hospital of Northern Theater Command from November 2016 to February2018,Twenty-five patients with STEMI were enrolled and randomized to balloon angioplasty or stenting(n=13)or adjunctive ELCA-treated study group(n=12).Baseline data of patients in the two groups were collected,including demographic information of patients,arterial blood pressure at admission,resting heart rateage,BMI,GRACE score,previous cardiovascular and cerebrovascular history,etc.The laboratory indicators mainly included serum cholesterol,serum triglyceride,serum creatinine,left ventricular ejection fraction,low density apolipoprotein,and left ventricular end-diastolic diameter.The parameters of ELCA contain laser ablation catheter diameter,laser energy and frequency,ablation time and laser ablation catheter pass rate.Indicators related to PCI consist of the range and length of the lesion,the stenosis of the vessel,the lumen diameter of the reference vessel,the lesion area of the target vessel,the amount of contrast agent,the stent index,etc.The observation end point was the immediate success rate before and after ELCA and after PCI.Minimal Lumen Diameter(MLD)was measured by Quantitative Coronary Angiography(QCA).With blood clots in the TIMI grade,Corrected TIMI flow frames(Corrected TIMI frames the count,CTFC),degree of residual Stenosis vascular lumen(Diameter Stenosis,DS),TIMI flow grade(thrombolysis in myocardial infarction flow)to evaluate target blood vessels.Safety endpoints included:laser treatment-related complications(including c-type and above dissection,perforation,slow flow,no reflow,and acute coronary artery occlusion,etc.)and PCI related complications(severe bleeding,stroke,and contrast nephropathy,etc.).The clinical success rate represents the inhibition of Major Adverse Cardiovascular Events(MACE)in patients during hospitalization and follow-up,among which the typical MACE Events are mainly manifested as recurrent angina pectoris,acute myocardial infarction,severe arrhythmia,heart failure and death from coronary heart disease.ResultsThe ELCA group had a lower left ventricular ejection fraction(LVEF)(49.0±11%vs 61.2±7.9%,P=0.006).There was no significant difference between the two groups in living habits,past history,and coronary angiography results(P>0.05).PCI related indicators in addition to balloon pre-expansion(P=0.022),the rest were no significant difference(P>0.05).Immediate success rate of ELCA groups was 100%,the occurrence of no-reflow,distal embolization or perforation was not identified by the core laboratory in any of the cases.In the control group,there were two case of slow blood flow and one case of no reflow.Immediate success rate of control groups was 76.9%.CTFC evaluation system was used to evaluate the blood flow of coronary artery immediately before and immediately after PCI.The ELCA group decreased from 67.81±16.5 to 34.63±14.7 and the control group decreased from 55.77±12.10 to 39.54±12.54.There was significant difference between the two groups(P<0.05).However,There was no significant difference in MLD and DS between two groups(P>0.05).Follow-up data of 180 days showed ELCA-treated study group were no MACE events.Two MACE events occurred in the control group(Heart failure hospitalized again)ConclusionThe application of ELCA can improve epicardial blood flow promote myocardial perfusion and have a high immediate procedure success rate and clinical success rate in patients with STEMI undergoing primary PCI with the low occurrence of slow/no-reflow.