EXCIMER-LASER CORONARY ANGIOPLASTY - THE NEW-APPROACHES-TO-CORONARY-INTERVENTION (NACI) EXPERIENCE

In the New Approaches to Coronary Intervention (NACI) registry, 887 pa tients were electively treated with excimer laser coronary angioplasty (ELCA) for coronary artery disease. The Advanced Interventional Syste m (AIS) system was used in 487 cases; the Spectranetics system, in 400 . The mean age was 63.4 years. Most patients had unstable angina (60.3 %); 43.7% had a prior myocardial infarction; and 18.6% were high risk or inoperable patients. Mean ejection fraction was 55.4%. A total of 1 ,000 lesions were treated in the 887 patients. Of the 1,000 lesions tr eated with ELCA in the 887 patients, 36% were in the right coronary ar tery; 33%, left anterior descending; 13%, circumflex; 3%, left main; a nd 16.6%, vein graft. By angiographic core laboratory analysis availab le for 752 (85%) patients with 839 lesions, lesions were 12.76 mm long . The minimum lumen diameter increased to 1.29 mm after the laser and finally to 1.95 mm after adjunctive percutaneous transluminal coronary angioplasty (PTCA) (which was performed in 93% of all lesions), with a final residual stenosis of 32.1% and Thrombolysis in Myocardial Infa rction (TIMI) grade 3 flow in 95%. Dissections of grades B, C, or D we re seen after 22.0% of initial laser attempts, and postlaser perforati ons were noted in 2.6%. Additional such dissections accumulated after adjunctive PTCA but the perforation rate remained low. Procedural succ ess was achieved in 84% of patients, but 1.2% died, 0.7% experienced Q -wave myocardial infarction (MI), and 2.7% required emergency bypass s urgery. Multiple logistic regression analysis could not identify any i ndependent predictors of these in-hospital complications. One-year mor tality was 5.7% and the cumulative incidence of Q-wave MI was 1.5%. Co ronary artery bypass graft (CABG) surgery was performed in 15.0% of pa tients whereas 25.5% required repeat percutaneous intervention with a target lesion revascularization rate of 31%. Independent predictors of death, Q-wave MI, or target lesion revascularization (which, combined , occurred in 35.6% of patients) were the absence of prior MI, ELCA in the circumflex, perforation after the procedure, and small (<2 mm) fi nal minimal lumen diameter. Considering the large number of patients w ith high-risk lesions, laser angioplasty was performed with excellent procedural success rates and a reasonable incidence of major complicat ions. (C) 1997 by Excerpta Medica, Inc.