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The impact of the excimer laser on myocardial salvage in ST-elevation acute myocardial infarction via nuclear scintigraphy

  • Naoki Shibata
  • Kensuke Takagi
  • Itsuro MorishimaEmail author
  • Naoki Yoshioka
  • Koichi Furui
  • Hiroaki Nagai
  • Yasunori Kanzaki
  • Ruka Yoshida
  • Yasuhiro Morita
  • Hideyuki Tsuboi
  • Toyoaki Murohara
Original Paper

Abstract

Data on the efficacy of excimer laser coronary atherectomy (ELCA) for patients with ST-elevation myocardial infarction (STEMI) are limited. Therefore, we sought to evaluate the impact of ELCA on myocardial salvage using nuclear scintigraphy in patients with STEMI. Between September 2014 and April 2017, we retrospectively enrolled 316 consecutive patients undergoing primary PCI (p-PCI) after their first STEMI in our institute. Of those, 72 patients with STEMI, an initial thrombolysis in myocardial infarction (TIMI) flow-0/1, and an onset to balloon time (OBT) < 6 h were included (ELCA, n = 32; non-ELCA, n = 40). The endpoint was the myocardial salvage index (MSI) based on a 17-segment model with a 5-point scoring system. MSI was calculated as: MSI = (∑123I-BMIPP defect score at 3–7 days after p-PCI - ∑99mTc-tetrofosmin defect score at 3–6 months after p-PCI)/∑123I-BMIPP defect score × 100 (%) at 3–7 days after p-PCI. The groups were compatible except in age (ELCA: 62.9 ± 12.4 years vs. non-ELCA: 69.8 ± 11.0 years) and loading antiplatelet drug (prasugrel: 100% vs. 40.0%). Direct implantation of shorter stents more frequently occurred in the ELCA group than in the non-ELCA group. MSI seemed to be better in the ELCA group compared with the non-ELCA group (57.6% vs. 45.6%, p = 0.09). This trend was emphasized when the final TIMI-3 flow was achieved (67.1% vs. 45.7%, p = 0.01). The nuclear scintigraphy results showed that ELCA can potentially improve myocardial salvage in patients with STEMI with OBT < 6 h and initial TIMI flow-0/1.

Keywords

Coronary intervention ST-elevation acute myocardial infarction excimer laser Nuclear scintigraphy Myocardial salvage 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Naoki Shibata
    • 1
  • Kensuke Takagi
    • 1
  • Itsuro Morishima
    • 1
    Email author
  • Naoki Yoshioka
    • 1
  • Koichi Furui
    • 1
  • Hiroaki Nagai
    • 1
  • Yasunori Kanzaki
    • 1
  • Ruka Yoshida
    • 1
  • Yasuhiro Morita
    • 1
  • Hideyuki Tsuboi
    • 1
  • Toyoaki Murohara
    • 2
  1. 1.Department of CardiologyOgaki Municipal HospitalOgaki, GifuJapan
  2. 2.Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan

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