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The International Journal of Cardiovascular Imaging

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01-01-2020 | Myocardial Infarction | Original Paper

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

Authors: Naoki Shibata, Kensuke Takagi, Itsuro Morishima, Naoki Yoshioka, Koichi Furui, Hiroaki Nagai, Yasunori Kanzaki, Ruka Yoshida, Yasuhiro Morita, Hideyuki Tsuboi, Toyoaki Murohara

Published in: The International Journal of Cardiovascular Imaging | Issue 1/2020

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.

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Title: The impact of the excimer laser on myocardial salvage in ST-elevation acute myocardial infarction via nuclear scintigraphy
Authors: Naoki Shibata
Kensuke Takagi
Itsuro Morishima
Naoki Yoshioka
Koichi Furui
Hiroaki Nagai
Yasunori Kanzaki
Ruka Yoshida
Yasuhiro Morita
Hideyuki Tsuboi
Toyoaki Murohara
Publication date: 01-01-2020
Publisher: Springer Netherlands
Keywords: Myocardial Infarction
Prasugrel
Scintigraphy
Laser
Published in: The International Journal of Cardiovascular Imaging / Issue 1/2020
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-019-01690-x

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

Abstract

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