Excimer Laser Coronary Angioplasty Versus Manual Aspiration Thrombectomy in Patients With ST- segment Elevation Myocardial Infarction: Analyzed by Nuclear Scintigraphy

Purpose: Clinical outcomes regarding the efficacy of excimer laser coronary angioplasty (ELCA) in real-world cases of acute myocardial infarction (MI) are limited. We evaluated the impact of ELCA on myocardial salvage and left ventricular (LV) systolic/diastolic function in patients with ST-segment elevation MI (STEMI) compared with manual aspiration thrombectomy using nuclear scintigraphy.Methods: We enrolled 143 consecutive STEMI patients treated with ELCA (63 patients) or manual aspiration thrombectomy (80 patients) between September 2016 and December 2020 in a single-center hospital. We checked peak creatine kinase (CK)/ creatine kinase-myocardial band (CK-MB) level and demonstrated single-photon emission computed tomography (SPECT) analyses with Quantitative Gated SPECT and Quantitative Perfusion SPECT (Auto QUANT 7.2) at 3–10 days using 123I-BMIPP and 3 months after percutaneous coronary intervention using 99mTc-tetrofosmin to evaluate myocardial salvage and LV systolic/diastolic function. Results: There was no significant difference in patients’ and periprocedural characteristics. Peak CK-MB level was significantly different between the groups (ELCA group, 190.0 [70.5–342.0] IU/L vs. aspiration group, 256.5 [157.0–354.8] IU/L, p=0.047). Although there was no significant difference in myocardial salvage, significant improvement in the LV ejection fraction (14.1 [6.2-19.8]% vs. 9.5 [3.9-15.3]%, respectively, p=0.017) and peak emptying rate (-0.54 [-1.02–-0.27] mL/s vs. -0.38 [-0.76–-0.05] mL/s, respectively, p=0.017) were detected.Conclusion: ELCA could suppress myocardial deviation enzymes and potentially improve systolic function in STEMI patients compared to manual aspiration thrombectomy.