Excimer laser-facilitated coronary angioplasty. Relative risk analysis of acute and follow-up results in 200 patients.

Abstract

BACKGROUND Excimer laser coronary angioplasty has been reported to be a promising treatment for complex coronary artery disease. The purpose of this study was to define the predictors of acute success and restenosis after this experimental intervention. METHODS AND RESULTS A cohort of 200 consecutive patients had a minimum of 6 months of follow-up evaluation after treatment of 215 coronary stenoses that were carefully selected for excimer laser coronary angioplasty. At the time of the initial procedure, the laser catheter alone produced a residual stenosis of less than or equal to 50% at 119 of 215 lesions (55.4%). For complete dilatation, 87.9% of the lesions required adjunctive balloon angioplasty. Clinical success was achieved in 183 of the 200 patients (91.5%), as indicated by a reduction by at least 20% of the narrowing of the vessel diameter, less than or equal to 50% residual stenosis, and no in-hospital complication. Complications included abrupt closure (5.0%), myocardial infarction (3.5%), bypass surgery (3.0%), perforation (2.0%), and death (0.0%). Logistic regression analysis showed that lesions at vessel bifurcations (success rate, 66%; adjusted odds ratio [OR] = 0.16; p = 0.002) or in tortuous vessels (success rate, 82%; OR = 0.48; p = 0.004) were associated with decreased clinical success. However, acceptable success rates were achieved in patients with lesions in saphenous vein grafts more than 3 years old (success rate, 94%; OR = 1.40; p = 0.75), in ostial lesions (success rate, 100%; OR = 3.36; p = 0.43), and in lesions longer than 10 mm (success rate, 93.5%; OR = 1.50; p = 0.39). Clinical follow-up was available in 197 of the 200 patients (98.5%) a mean of 5.9 +/- 1.9 months after angioplasty, at which time 31.0% of patients had developed symptoms or evidence of ischemia. No patient died during the study. Follow-up angiography was obtained in 83.1% of eligible patients after a mean [+/- SD] of 5.2 +/- 2.0 months. Angiographic restenosis, defined by greater than 50% stenosis, appeared at 78 of 164 lesions (47.6%). By logistic regression analysis, only lesions in saphenous vein grafts were associated with a decreased rate of restenosis (restenosis rate, 20%; OR = 0.18; p = 0.01). CONCLUSIONS This analysis, which defines the profile of risk for excimer laser angioplasty, provides a sound basis for rigorous comparison of adjunctive excimer laser with balloon angioplasty for ostial narrowings, long lesions, and saphenous vein graft stenoses.