CLINICAL EVENTS FOLLOWING EXCIMER-LASER ANGIOPLASTY OR BALLOON ANGIOPLASTY FOR COMPLEX CORONARY LESIONS - SUBANALYSIS OF A RANDOMIZED TRIAL

Objectives-To compare clinical outcome in patients with complex corona ry lesions treated with either excimer laser coronary angioplasty (ELC A) or balloon angioplasty. Patients and design-308 patients with stabl e angina and a coronary lesion of more than 10 mm in length were rando mised to ELCA (151 patients, 158 lesions) or balloon angioplasty (157 patients, 167 lesions). The primary clinical end points were death, my ocardial infarction, coronary bypass surgery, or repeated coronary ang ioplasty of the randomised segment during six months of follow up. Sub analysis was performed to identify a subgroup of patients with a benef icial clinical outcome following ELCA or balloon angioplasty. Setting- Two university hospitals and one general hospital. Results-There were no deaths. Myocardial infarction, coronary bypass surgery, and repeate d angioplasty occurred in 4.6, 10.6, and 21.2%, respectively, of patie nts treated with ELCA compared with 5.7, 10.8, and 18.5%, respectively , of those treated with balloon angioplasty. ELCA did not yield a favo urable clinical outcome in subgroups of patients with long (more than 20 mm) coronary lesions, calcified lesions, small diseased vessels (le ss than or equal to 2.5 mm reference diameter), or total coronary occl usions. There was a worse clinical outcome in patients with tandem les ions treated with ELCA compared with balloon angioplasty (9/18 v 3/26 lesions; p = 0.01); while a trend towards an unfavourable clinical out come was found in patients with vessels with a reference diameter of m ore than 2.5 mm (23/66 v 13/63 lesions, p = 0.07) and left circumflex coronary lesions (12/41 v 6/42 lesions, p = 0.08). Conclusions-The fin dings indicate a worse clinical outcome in patients with lesions of mo re than 10 mm treated with ELCA compared with balloon angioplasty who have tandem coronary lesions and in those with vessels with a referenc e diameter of more than 2.5 nun and left circumflex coronary lesions.