Excimer laser angioplasty in acute myocardial infarction (the CARMEL multicenter trial)
| Autor: | Douglas Ebersole, Tony Das, Kishor Vora, John D. Baker, David Hilton, Edwin L. Alderman, Hooman Madyoon, On Topaz, Johannes B. Dahm |
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| Rok vydání: | 2004 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Perforation (oil well) Myocardial Infarction Coronary Angiography Angioplasty Laser Severity of Illness Index Ventricular Function Left Internal medicine Multicenter trial Angioplasty Humans Medicine Saphenous Vein cardiovascular diseases Myocardial infarction Thrombus Ejection fraction business.industry Cardiogenic shock Middle Aged medicine.disease United States Treatment Outcome Cardiology Female Cardiology and Cardiovascular Medicine business TIMI |
| Zdroj: | The American Journal of Cardiology. 93:694-701 |
| ISSN: | 0002-9149 |
| DOI: | 10.1016/j.amjcard.2003.11.050 |
| Popis: | Patients with acute myocardial infarction (AMI) with thrombus-laden lesions constitute a revascularization challenge. Thrombus and atherosclerotic plaque absorb laser energy; thus, we studied the safety and efficacy of excimer laser in AMI. In a multicenter trial, 151 patients with AMI underwent excimer laser angioplasty. Baseline left ventricular ejection fraction was 44 +/- 13%, and 13% of patients were in cardiogenic shock. A saphenous vein graft was the target vessel in 21%. Quantitative coronary angiography and statistical analysis were performed by independent core laboratories. A 95% device success, 97% angiographic success, and 91% overall procedural success rate were recorded. Maximal laser gain was achieved in lesions with extensive thrombus burden (p0.03 vs small burden). Thrombolysis In Myocardial Infarction (TIMI) trial flow increased significantly by laser: 1.2 +/- 1.1 to 2.8 +/- 0.5 (p0.001), reaching a final 3.0 +/- 0.2 (p0.001 vs baseline). Minimal luminal diameter increased by laser from 0.5 +/- 0.5 to 1.6 +/- 0.5 mm (mean +/- SD, p0.001), followed by 2.7 +/- 0.6 mm after stenting (p0.001 vs baseline and vs after laser). Laser decreased target stenosis from 83 +/- 17% to 52 +/- 15% (mean +/- SD, p0.001 vs baseline), followed by 20 +/- 16% after stenting (p0.001 vs baseline and vs after laser). Six patients (4%) died, each presented with cardiogenic shock. Complications included perforation (0.6%), dissection (5% major, 3% minor), acute closure (0.6%), distal embolization (2%), and bleeding (3%). In a multivariant regression model, absence of cardiogenic shock was a significant factor affecting procedural success. Thus, in the setting of AMI, gaining maximal thrombus dissolution in lesions with extensive thrombus burden, combined with a considerable increase in minimal luminal diameter and restoration of anterograde TIMI flow, support successful debulking by excimer laser. The presence of thrombus does not adversely affect procedural success; however, cardiogenic shock remains a predictor of major adverse events during hospitalization. |
| Databáze: | OpenAIRE |
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