Effectiveness of Excimer Laser Coronary Angioplasty in Acute Myocardial Infarction or in Unstable Angina Pectoris On Topaz, MD, Nelson L. Bernardo, MD, Rakesh Shah, MD, Robert H. McQueen, MD, Pratik Desai, MD, Yves Janin, MD, Alexandra J. Lansky, MD, and Marc E. Carr, Jr., MD, PhD This study was conducted to evaluate the feasibility, safety, and acute results of percutaneous excimer laser coronary angioplasty (ELCA) in acute coronary syn- dromes. Fifty-nine patients were treated with ELCA (308 nm), including 33 patients with unstable angina pectoris (UAP) (35 vessels with 39 lesions) and 26 patients with acute myocardial infarction (AMI) (26 vessels with 29 lesions). In each patient the target lesion had a complex morphology. Overall, 71% of the patients had contrain- dications for pharmacologic thrombolytic agents or gly- coprotein IIb/IIIa receptor antagonists. All patients re- ceived adjunct balloon dilation followed by stent implantation in 88% of patients with AMI versus 76% of patients with UAP (p  NS). Quantitative angiography was performed at an independent core laboratory; 86% laser success and 100% procedural success was achieved in the AMI group versus 87% laser success and 97% procedural success in the UAP group (p  NS). In the AMI group, the minimal luminal diameter increased from 0.77  0.56 to 1.44  0.47 mm after lasing to a final 2.65  0.47 mm versus 0.77  0.38 to 1.35  0.4 mm after lasing to 2.66  0.5 mm final in the UAP group. A prelaser percent stenosis of 76  17% for the AMI group versus 70  16% for the UAP group (p  NS) was decreased after lasing to 52  16% for the AMI group versus 51  14% for the UAP group (p  NS) and to a final stenosis of 15  17% for the AMI group versus 12  15% for the UAP group (p  NS). A 96% laser- induced reduction of thrombus burden area was achieved in the AMI group versus 97% in the UAP group (p  NS). Preprocedure Thrombolysis In Myocardial In- farction flow of 1.3  0.9 in the AMI group versus 2.3  1.2 for the UAP group (p  0.01) increased to a final flow of 3.0  0 for the AMI group versus 3.0  0 for the UAP group (p  NS). There were no deaths, cerebro- vascular accident, emergency bypass surgery, acute clo- sure, major perforation or major dissection, distal em- bolization, or bleeding complications in either group. One patient with AMI had localized perforation (caused by guidewire) without sequelae and 1 patient with UAP had an abnormal increase in creatine kinase levels. All 59 patients survived the laser procedure, improved clin- ically, and were discharged. Thus, early experience in patients with acute coronary syndromes suggest that percutaneous ELCA is feasible and safe. 2001 by Excerpta Medica, Inc. (Am J Cardiol 2001;87:849 – 855) T he presence of intracoronary thrombus in acute coronary syndromes indicates a higher risk for complications during and after coronary intervention. 1 Patients with acute coronary syndromes, including acute myocardial infarction (AMI) or unstable angina pectoris (UAP), sometimes require mechanical re- moval of the occlusive coronary thrombus and the underlying occlusive stenosis. Laser is an approved technique for debulking of lesions considered “non- ideal” for standard balloon angioplasty. Because ath- erosclerotic plaques and thrombi avidly absorb laser energy in the ultraviolet (excimer) wavelength, 2–6 we conducted a study to examine and compare the feasi- bility, safety, and the acute results of percutaneous excimer laser coronary angioplasty (ELCA) in pa- tients with AMI or UAP. METHODS Study population: Patients with acute coronary syn- dromes were eligible for enrollment if they had either one of these clinical features: (1) AMI within 24 hours after the onset of symptoms that necessitated rescue percutaneous intervention for continuous chest pain and ischemia; (2) unstable angina with 2 episodes of angina at rest associated with ischemic changes on electrocardiogram at rest, including ST-segment ele- vation or depression of 1 mm in 2 continuous electrocardiographic leads or T-wave inversion, dur- ing the previous 24 hours, despite medical therapy. Specifically, the investigators sought to include pa- tients who failed to respond to thrombolytic agents or to glycoprotein (GP) IIb/IIIa blockers or had contra- indications to thrombolytic therapy or GPIIb/IIIa re- ceptor antagonists. These contraindications included active bleeding, history of significant bleeding or re- From the Divisions of Cardiology and Hematology (Coagulation Spe- cial Studies Laboratory), Medical College of Virginia Hospitals, Med- ical College of Virginia, Virginia Commonwealth University, Rich- mond, Virginia; and Angiographic Core Laboratories, Washington Hospital Center, Washington, DC. Manuscript received August 10, 2000; revised manuscript received and accepted October 16, 2000. Address for reprints: On Topaz, MD, Division of Cardiology, McGuire VA Medical Center, Medical College of Virginia, 1201 Broad Rock Blvd., Richmond, Virginia 23249. E-mail: ONTOPAZ@ aol.com. 849 ©2001 by Excerpta Medica, Inc. All rights reserved. 0002-9149/01/$–see front matter The American Journal of Cardiology Vol. 87 April 1, 2001 PII S0002-9149(00)01525-3