The changing profile of patient selection, procedural techniques, and outcomes in excimer laser coronary angioplasty
During the course of development of excimer laser angioplasty, several changes in patient selection and technique have occurred. It is uncertain however whether these changes have been associated with improved procedural outcome. In this study multivariable regression methods were used to identify the factors responsible for clinical success major complications and vessel perforation in 2,041 consecutive patients treated with excimer laser coronary angioplasty. The overall rates of clinical success were 89% major complications 7.5% and vessel perforation 2.1%. Clinical success was 86% in patients treated with prototype catheters 89% with flexible catheters 92% with extremely flexible catheters and 95% in patients treated with directional eccentric catheters (P < 0.001). By multivariable analysis clinical success increased with each subsequent catheter design (odds ratio [OR] = 1.4 per iteration [95% confidence interval 1.2, 1.6]) and with improved lesion selection. Major complications were reduced when operators had performed more than 25 cases (rate = 6.5% OR = 0.7 [0.5 0.9]) and the incidence of vessel perforation was decreased when the size of the target vessel was > 1.0 mm larger than the diameter of the laser catheter (rate = 1.1% OR = 0.3 [0.2, 0.5]). In conclusion during the course of clinical investigation with excimer laser angioplasty procedural outcome has improved. These results emphasize the importance of careful patient selection and procedural technique to enhance the success of excimer laser angioplasty.