The effect of excimer laser coronary angioplasty (ELCA) on reperfusion injury in ST elevation myocardial infarction: the LAST-PASS cardiac MRI sub-study (RF_TH_184)

Thursday, January 30, 2025

2:00 PM – 2:10 PM East Coast USA Time

Location: Blue Room PreFunction

Presenting Author(s)

Yoko Kato, MD, PhD

Research Associate
The Johns Hopkins University

Primary Author(s)

Yoko Kato, MD, PhD

Research Associate
The Johns Hopkins University

Co-Author(s)

MN

Makoto Natsumeda, MD

Associate Professor
Tokai University Hospital, Japan
KT

Kensuke Takagi, MD, PhD

Chief physician
National Cerebral and Cardiovascular Center Hospital, Japan
Bharath Ambale-Venkatesh, PhD

Physicist
The John Hopkins Hospital
YO

Yoshiaki Ohyama, MD, PhD

Clinical Investigation and Research Unit, Gunma University Hospital, Japan
CN

Chikara Noda, PhD

Research associate
The Johns Hopkins University
MO

Mohammad Ostovaneh, MD

Cardiology Fellow
The John Hopkins Hospital
YI

Yuji Ikari, MD, PhD

Professor, director
Tokai University, Japan
Joao A. C Lima, MD

Professor
The Johns Hopkins University

Background: Excimer laser coronary angioplasty (ELCA) is a lesion modification device that vaporizes and debulks plaques and thrombi [1,2], and is expected to reduce distal embolization during percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). We have recently conducted the “Laser Atherectomy for STEMI, PCI Analysis with Scintigraphy Study (LAST-PASS)”, a multi-center prospective study in Japan (NCT03950310). The main study did not show efficacy of ELCA regarding its primary endpoint of myocardial salvage by scintigraphy. In the LAST-PASS cardiac magnetic resonance imaging (CMR) sub-study, we aimed to assess the effect of ELCA on reperfusion injury indexed as microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH), which are established prognostic markers post-STEMI [3,4].

Methods:

The LAST-PASS study randomly allocated participants to ELCA or conventional PCI arm in a 1:1 ratio, and included only patients with a first-episode STEMI treated with primary PCI caused by proximal left anterior descending artery (LAD) culprit lesion of < 6 hrs onset, having initial Thrombolysis In Myocardial Infarction (TIMI) flow of 0 or1. Exclusion criteria included a history of coronary artery bypass graft surgery or the presence of any cardiac device. Participants without atrial fibrillation underwent CMR at acute (5-9 days post-STEMI) and chronic (6 months post-STEMI) phases. CMR protocol included CINE, T2WBB, and late gadolinium enhancement (LGE) (at 17 min post 0.15 mmol/kg of Gadovist, Bayer Schering Pharma, Berlin-Wedding, Germany) [5]. Images were quantified using QMass version 7.6 (Medis Medical Imaging Systems, Leiden, the Netherlands). The effect of ELCA on IMH or MVO was assessed using multivariable regression analyses, with adjustments for clinical and interventional covariates through stepwise forward selection (p< 0.2).

Results: Sixty-six participants were enrolled in the CMR study. Demographics, interventional, and CMR measurements including the presence and size of MVO and IMH were comparable between ELCA and control groups. However, ELCA group had less aspiration (i.e., intracoronary thrombectomy device that vacuums the thrombus) use and lower acute phase left ventricular ejection fraction (LVEF) (Table 1). In the multivariable analysis, ELCA did not influence the presence or size of IMH and MVO (Table 1). Post-hoc analysis on the combined effect of ELCA and aspiration use suggested a trend to reduce MVO. Representative images in Figure 1.

Conclusion:

ELCA did not show benefit in diminishing IMH or MVO, which may suggest that debulking the thrombus without reducing its total volume may be insufficient to prevent reperfusion injury [6,7]. Post-hoc analysis suggests the possible synergy of ELCA with aspiration. CMR successfully quantifies IMH and MVO and represents the most powerful phenotyping tool for post-MI reperfusion injury quantification.