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Titolo:
EXCIMER-LASER CORONARY ANGIOPLASTY - THE NEW-APPROACHES-TO-CORONARY-INTERVENTION (NACI) EXPERIENCE
Autore:
HOLMES DR; MEHTA S; GEORGE CJ; MARGOLIS JR; LEON MB; ISNER JM; BITTL JA; KING SB; SIEGEL RM; SKETCH MH; COWLEY MJ; ROUBIN GS; BRINKER JA; OVERLIE PA; TCHENG J; SANBORN TA; LITVACK F;
Indirizzi:
MAYO CLIN & MAYO FDN,200 1ST ST SW ROCHESTER MN 55905 CEDARS MED CTR MIAMI FL 00000 UNIV PITTSBURGH,DEPT EPIDEMIOL PITTSBURGH PA 15261 CEDARS SINAI MED CTR LOS ANGELES CA 90048 MIAMI HEART INST MIAMI FL 00000 WASHINGTON HEART CTR,DEPT INTERNAL MED CARDIOL WASHINGTON DC 00000 BRIGHAM & WOMENS HOSP BOSTON MA 02115 EMORY UNIV ATLANTA GA 30322 ADV CARDIAC SPECIALISTS GILBERT AZ 00000 ST ELIZABETHS HOSP BOSTON BOSTON MA 00000 CORNELL MED CTR NEW YORK NY 00000 DUKE MED CTR DURHAM NC 00000 VIRGINIA COMMONWEALTH UNIV,MED COLL VIRGINIA RICHMOND VA 23298 UNIV ALABAMA BIRMINGHAM AL 00000 JOHNS HOPKINS UNIV HOSP BALTIMORE MD 21287 CARDIOL ASSOCIATES LUBBOCK LUBBOCK TX 00000
Titolo Testata:
The American journal of cardiology
fascicolo: 10A, volume: 80, anno: 1997,
pagine: 99 - 105
SICI:
0002-9149(1997)80:10A<99:ECA-TN>2.0.ZU;2-#
Fonte:
ISI
Lingua:
ENG
Soggetto:
RANDOMIZED TRIAL; ABLATION; SALINE;
Tipo documento:
Article
Natura:
Periodico
Citazioni:
17
Recensione:
Indirizzi per estratti:
Citazione:
D.R. Holmes et al., "EXCIMER-LASER CORONARY ANGIOPLASTY - THE NEW-APPROACHES-TO-CORONARY-INTERVENTION (NACI) EXPERIENCE", The American journal of cardiology, 80(10A), 1997, pp. 99-105

Abstract

In the New Approaches to Coronary Intervention (NACI) registry, 887 patients were electively treated with excimer laser coronary angioplasty (ELCA) for coronary artery disease. The Advanced Interventional System (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 riskor 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 treated with ELCA in the 887 patients, 36% were in the right coronary artery; 33%, left anterior descending; 13%, circumflex; 3%, left main; and 16.6%, vein graft. By angiographic core laboratory analysis available 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 andfinally to 1.95 mm after adjunctive percutaneous transluminal coronary angioplasty (PTCA) (which was performed in 93% of all lesions), witha final residual stenosis of 32.1% and Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow in 95%. Dissections of grades B, C, or D were seen after 22.0% of initial laser attempts, and postlaser perforations were noted in 2.6%. Additional such dissections accumulated afteradjunctive PTCA but the perforation rate remained low. Procedural success was achieved in 84% of patients, but 1.2% died, 0.7% experienced Q-wave myocardial infarction (MI), and 2.7% required emergency bypass surgery. Multiple logistic regression analysis could not identify any independent predictors of these in-hospital complications. One-year mortality was 5.7% and the cumulative incidence of Q-wave MI was 1.5%. Coronary artery bypass graft (CABG) surgery was performed in 15.0% of patients whereas 25.5% required repeat percutaneous intervention with atarget 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) final minimal lumen diameter. Considering the large number of patients with high-risk lesions, laser angioplasty was performed with excellentprocedural success rates and a reasonable incidence of major complications. (C) 1997 by Excerpta Medica, Inc.

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Documento generato il 27/11/20 alle ore 15:23:31