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Excimer laser coronary angioplasty versus manual aspiration thrombectomy in patients with ST-segment elevation myocardial infarction: analyzed by nuclear scintigraphy

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Abstract

Clinical outcomes concerning the efficacy of excimer laser coronary angioplasty (ELCA) in real-world cases of acute myocardial infarction (MI) are limited. We evaluated and compared the impact of ELCA with manual aspiration thrombectomy on myocardial salvage and left ventricular (LV) systolic/diastolic function in patients with ST-segment elevation MI (STEMI) using nuclear scintigraphy.  We enrolled 143 consecutive patients with STEMI treated with ELCA (63 patients) or manual aspiration thrombectomy (80 patients) between September 2016 and December 2020 in a single-center hospital. We evaluated the peak creatine kinase (CK)/ creatine kinase-myocardial band (CK-MB) levels and performed single-photon emission computed tomography (SPECT) analyses with Quantitative Gated SPECT and Quantitative Perfusion SPECT (Auto QUANT 7.2) at 3–10 days using 123I-BMIPP and 3 months following percutaneous coronary intervention using 99mTc-tetrofosmin to evaluate myocardial salvage and LV systolic/diastolic function. No significant difference was observed in the patient and periprocedural characteristics. Peak CK-MB level was significantly different between the groups (ELCA group, 190.0 [70.5–342.0] IU/L vs. aspiration group, 256.5 [157.0–354.8] IU/L, p = 0.047). Although no significant difference was observed in myocardial salvage, significant improvement in the LV ejection fraction (14.1 [6.2–19.8]% vs. 9.5 [3.9–15.3]%, respectively, p = 0.018) and peak emptying rate (-0.54 [-1.02– (-0.27)] mL/s vs. -0.38 [-0.76– (-0.05)] mL/s, respectively, p = 0.017) were detected. ELCA could suppress the myocardial deviation enzymes and potentially improve systolic function compared to manual aspiration thrombectomy in patients with STEMI.

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Data availability

The deidentified participant data will be shared on a request basis. Kindly directly contact the corresponding author to request data sharing. All the analyzable datasets related to the study, study protocol, and statistical analysis plan will be made available. The data will become available immediately following publication, ending a year after the publication. For any purpose, the data will be shared as Excel files via E-mail.

References

  1. Kimura K, Kimura T, Ishihara M, Nakagawa Y, Nakao K, Miyauchi K et al (2019) JCS 2018 guideline on diagnosis and treatment of acute coronary syndrome. Circ J 83:1085–1196. https://doi.org/10.1253/circj.CJ-19-0133

    Article  CAS  PubMed  Google Scholar 

  2. Morishima I, Sone T, Okumura K, Tsuboi H, Kondo J, Mukawa H et al (2000) Angiographic no-reflow phenomenon as a predictor of adverse long-term outcome in patients treated with percutaneous transluminal coronary angioplasty for first acute myocardial infarction. J Am Coll Cardiol 36:1202–1209. https://doi.org/10.1016/s0735-1097(00)00865-2

    Article  CAS  PubMed  Google Scholar 

  3. Morishima I, Sone T, Mokuno S, Taga S, Shimauchi A, Oki Y, Kondo J, Tsuboi H, Sassa H (1995) Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty. Am Heart J 130:239–243. https://doi.org/10.1016/0002-8703(95)90434-4

    Article  CAS  PubMed  Google Scholar 

  4. De Luca G, Ernst N, Zijlstra F, van ’t Hof AWJ, Hoorntje JCA, Dambrink JH et al (2004) Preprocedural TIMI flow and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol 43:1363–1367. https://doi.org/10.1016/j.jacc.2003.11.042

    Article  PubMed  Google Scholar 

  5. Ikari Y, Sakurada M, Kozuma K, Kawano S, Katsuki T, Kimura K et al (2008) Upfront thrombus aspiration in primary coronary intervention for patients with ST-segment elevation acute myocardial infarction: report of the VAMPIRE (VAcuuM asPIration thrombus REmoval) trial. JACC Cardiovasc Interv 1:424–431. https://doi.org/10.1016/j.jcin.2008.06.004

    Article  PubMed  Google Scholar 

  6. Jolly SS, James S, Džavík V, Cairns JA, Mahmoud KD, Zijlstra F et al (2017) Thrombus aspiration in ST-segment-elevation myocardial infarction: an individual patient meta-analysis: thrombectomy trialists collaboration. Circulation 135:143–152. https://doi.org/10.1161/CIRCULATIONAHA.116.025371

    Article  PubMed  Google Scholar 

  7. Elgendy IY, Huo T, Bhatt DL, Bavry AA (2015) Is aspiration thrombectomy beneficial in patients undergoing primary percutaneous coronary intervention? Meta-analysis of randomized trials. Circ Cardiovasc Interv 8:e002258. https://doi.org/10.1161/CIRCINTERVENTIONS.114.002258

    Article  PubMed  Google Scholar 

  8. Rawlins J, Din JN, Talwar S, O’Kane P (2016) Coronary intervention with the excimer laser: review of the technology and outcome data. Interv Cardiol 11:27–32. https://doi.org/10.15420/icr.2016:2:2

    Article  PubMed  PubMed Central  Google Scholar 

  9. Sintek M, Coverstone E, Bach R, Zajarias A, Lasala J, Kurz H et al (2021) Excimer laser coronary angioplasty in coronary lesions: use and safety from the NCDR/CATH PCI registry. Circ Cardiovasc Interv 14:e010061. https://doi.org/10.1161/CIRCINTERVENTIONS.120.010061

    Article  CAS  PubMed  Google Scholar 

  10. Shibata N, Takagi K, Morishima I, Yoshioka N, Furui K, Nagai H et al (2020) The impact of the excimer laser on myocardial salvage in ST-elevation acute myocardial infarction via nuclear scintigraphy. Int J Cardiovasc Imaging 36:161–170. https://doi.org/10.1007/s10554-019-01690-x

    Article  PubMed  Google Scholar 

  11. Nishino M, Mori N, Takiuchi S, Shishikura D, Doi N, Kataoka T et al (2017) Indications and outcomes of excimer laser coronary atherectomy: efficacy and safety for thrombotic lesions-The ULTRAMAN registry. J Cardiol 69:314–319. https://doi.org/10.1016/j.jjcc.2016.05.018

    Article  PubMed  Google Scholar 

  12. Topaz O, Ebersole D, Das T, Alderman EL, Madyoon H, Vora K et al (2004) Excimer laser angioplasty in acute myocardial infarction (the CARMEL multicenter trial). Am J Cardiol 93:694–701. https://doi.org/10.1016/j.amjcard.2003.11.050

    Article  PubMed  Google Scholar 

  13. Shishikura D, Otsuji S, Takiuchi S, Fukumoto A, Asano K, Ikushima M et al (2013) Vaporizing thrombus with excimer laser before coronary stenting improves myocardial reperfusion in acute coronary syndrome. Circ J 77:1445–1452. https://doi.org/10.1253/circj.cj-12-1064

    Article  PubMed  Google Scholar 

  14. Ilkay E, Karaca I, Yavuzkir M, Akbulut M, Pekdemir M (2005) The effect of interventional treatment in acute myocardial infarction on ST resolution: a comparison of coronary angioplasty with excimer laser angioplasty. Angiology 56:377–384. https://doi.org/10.1177/000331970505600403

    Article  PubMed  Google Scholar 

  15. Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ et al (1996) TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation 93:879–888. https://doi.org/10.1161/01.cir.93.5.879

    Article  CAS  PubMed  Google Scholar 

  16. Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542. https://doi.org/10.1161/hc0402.102975

    Article  PubMed  Google Scholar 

  17. Nakajima K, Nishimura T (2006) Inter-institution preference-based variability of ejection fraction and volumes using quantitative gated SPECT with 99mTc-tetrofosmin: a multicentre study involving 106 hospitals. Eur J Nucl Med Mol Imaging 33:127–133. https://doi.org/10.1007/s00259-005-1916-7

    Article  PubMed  Google Scholar 

  18. Laskey WK, Yancy CW, Maisel WH (2007) Thrombosis in coronary drug-eluting stents: report from the meeting of the circulatory system medical devices advisory panel of the food and drug administration center for devices and radiologic health, December 7–8, 2006. Circulation 115:2352–2357. https://doi.org/10.1161/CIRCULATIONAHA.107.688416

    Article  PubMed  Google Scholar 

  19. Kanda Y (2013) Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant 48:452–458. https://doi.org/10.1038/bmt.2012.244

    Article  CAS  PubMed  Google Scholar 

  20. Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ et al (2008) Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet 371:1915–1920. https://doi.org/10.1016/S0140-6736(08)60833-8

    Article  PubMed  Google Scholar 

  21. Fröbert O, Lagerqvist B, Olivecrona GK, Omerovic E, Gudnason T, Maeng M et al (2013) Thrombus aspiration during ST-segment elevation myocardial infarction. N Engl J Med 369:1587–1597. https://doi.org/10.1056/NEJMoa1308789

    Article  CAS  PubMed  Google Scholar 

  22. Jolly SS, Cairns JA, Yusuf S, Meeks B, Gao P, Hart RG et al (2015) Stroke in the TOTAL trial: a randomized trial of routine thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction. Eur Heart J 36:2364–2372. https://doi.org/10.1093/eurheartj/ehv296

    Article  PubMed  PubMed Central  Google Scholar 

  23. Hibi K, Kozuma K, Maejima N, Sonoda S, Endo T, Tanaka H et al (2020) Long-term clinical outcomes after filter protection during percutaneous coronary intervention in patients with attenuated plaque – 1-year follow up of the VAMPIRE 3 (vacuum aspiration Thrombus Reemoval 3) trial. Circ J 85:44–49. https://doi.org/10.1253/circj.CJ-20-0449

    Article  PubMed  Google Scholar 

  24. Stone GW, Maehara A, Witzenbichler B, Godlewski J, Parise H, Dambrink JH et al (2012) Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA 307:1817–1826. https://doi.org/10.1001/jama.2012.421

    Article  CAS  PubMed  Google Scholar 

  25. Hartman MHT, Eppinga RN, Vlaar PJJ, Lexis CPH, Lipsic E, Haeck JDE et al (2017) The contemporary value of peak creatine kinase-MB after ST-segment elevation myocardial infarction above other clinical and angiographic characteristics in predicting infarct size, left ventricular ejection fraction, and mortality. Clin Cardiol 40:322–328. https://doi.org/10.1002/clc.22663

    Article  PubMed  Google Scholar 

  26. Topaz O, Minisi AJ, Bernardo NL, McPherson RA, Martin E, Carr SL, Carr ME (2001) Alterations of platelet aggregation kinetics with ultraviolet laser emission: the “stunned platelet” phenomenon. Thromb Haemost 86:1087–1093. https://doi.org/10.1055/s-0037-1616537

    Article  CAS  PubMed  Google Scholar 

  27. Topaz O, Ebersole D, Dahm JB, Alderman EL, Madyoon H, CARMEL Excimer Laser Interventional Study Group et al (2008) Excimer laser in myocardial infarction: a comparison between STEMI patients with established Q-wave versus patients with non-STEMI (non-Q). Lasers Med Sci 23:1–10. https://doi.org/10.1007/s10103-007-0444-z

    Article  PubMed  Google Scholar 

  28. Oraevsky AA, Jacques SL, Pettit GH, Saidi IS, Tittel FK, Henry PD (1992) XeCl laser ablation of atherosclerotic aorta: optical properties and energy pathways. Lasers Surg Med 12:585–597. https://doi.org/10.1002/lsm.1900120604

    Article  CAS  PubMed  Google Scholar 

  29. Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Koschalka A, Navarra JL et al (2020) Culprit vessel-related myocardial mechanics and prognostic implications following acute myocardial infarction. Clin Res Cardiol 109:339–349. https://doi.org/10.1007/s00392-019-01514-x

    Article  PubMed  Google Scholar 

  30. Asanuma T, Fukuta Y, Masuda K, Hioki A, Iwasaki M, Nakatani S (2012) Assessment of myocardial ischemic memory using speckle tracking echocardiography. JACC Cardiovasc Imaging 5:1–11. https://doi.org/10.1016/j.jcmg.2011.09.019

    Article  PubMed  Google Scholar 

  31. Ishii K, Suyama T, Imai M, Maenaka M, Yamanaka A, Makino Y et al (2009) Abnormal regional left ventricular systolic and diastolic function in patients with coronary artery disease undergoing percutaneous coronary intervention: clinical significance of post-ischemic diastolic stunning. J Am Coll Cardiol 54:1589–1597. https://doi.org/10.1016/j.jacc.2009.06.030

    Article  PubMed  Google Scholar 

  32. Baumbach A, Bittl JA, Fleck E, Geschwind HJ, Sanborn TA, Tcheng JE, Karsch KR (1994) Acute complications of excimer laser coronary angioplasty: a detailed analysis of multicenter results. Coinvestigators of the U.S. and European percutaneous excimer laser coronary angioplasty (PELCA) Registries. J Am Coll Cardiol 23:1305–1313. https://doi.org/10.1016/0735-1097(94)90371-9

    Article  CAS  PubMed  Google Scholar 

  33. Bittl JA (2008) Physical aspects of excimer laser angioplasty for undilatable lesions. Catheter Cardiovasc Interv 71:808–809. https://doi.org/10.1002/ccd.21593

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu, Japan

    Kazuki Shimojo, Naoki Shibata, Kensuke Takagi, Hirotsugu Mitsuhashi, Yasuhiro Morita, Yasunori Kanzaki, Naoki Watanabe, Naoki Yoshioka, Hiroyuki Miyazawa, Takuro Imaoka, Gaku Sakamoto, Takuma Ohi, Hiroki Goto, Hoshito Karasawa & Itsuro Morishima

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Contributions

All the authors contributed to the study conception, design, material preparation, data collection and analysis. The first draft of the manuscript was written by KS and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Itsuro Morishima.

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This study was conducted in accordance with the Declaration of Helsinki. Approval was granted by the Medical Ethics Committee of Ogaki Municipal Hospital (Reference number: 20210916-9).

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Written informed consent was obtained from each patient or a relative before or after undergoing PCI.

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Shimojo, K., Shibata, N., Takagi, K. et al. Excimer laser coronary angioplasty versus manual aspiration thrombectomy in patients with ST-segment elevation myocardial infarction: analyzed by nuclear scintigraphy. Int J Cardiovasc Imaging 39, 831–842 (2023). https://doi.org/10.1007/s10554-022-02771-0

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