6-MONTH OUTCOME AND DETERMINANTS OF ADVERSE CLINICAL EVENTS AFTER SUCCESSFUL EXCIMER-LASER CORONARY ANGIOPLASTY

Objective: To describe the six month outcome and predictors of adverse clinical events following successful excimer laser coronary angioplas ty (ELCA). Design: Retrospective analysis of comprehensive data collec ted at time of initial procedure and during planned follow-up interval s. Setting: There were 35 participating institutions throughout the Un ited States. Patients: The study population was comprised of 3,069 pat ients who had successful ELCA and completed follow-up at 6 months, rep resenting 91% of eligible cases. Forty percent had prior balloon angio plasty and 34% had prior bypass surgery. Measurements: Patient symptom atology was assessed by Canadian Cardiovascular Society functional (CC SF) class. Interim adverse clinical events [death, Q wave myocardial i nfarction (QMI), repeat intervention, bypass surgery, and a composite end-point] were tracked. Twenty-six pre-ELCA clinical, angiographic an d procedural variables were evaluated to assess their ability to predi ct outcome.Results: At 6 months, there was 2.8% mortality, 2.5% incide nce of QMI, and 28.7% required either repeat intervention or bypass su rgery. Overall, 69.2% of patients had no adverse event. In this cohort , the pre-ELCA CCSF class grade was 2.7 +/- 1.2, but at 6 months, it w as 0.7 +/- 1.1 (p < 0.001). The multivariate predictors of the composi te end point were gender, stenosis location, and rest and unstable ang ina. Conclusions: There is an excellent 6 month outcome after successf ul ELCA in this selected population with complex coronary artery disea se. The majority of patients without interim events enjoy significant alleviation of symptoms. The predictors of adverse events are clinical rather than angiographic.