Key result
Excimer laser coronary atherectomy-assisted PCI did not significantly reduce major adverse cardiovascular events compared with standard PCI alone (RR 0.90; 95% CI 0.62-1.29).
Why the study?
The clinical benefit of excimer laser coronary atherectomy during PCI for ACS remains controversial, with inconsistent previous results and a lack of quantitative synthesis.
Does excimer laser coronary atherectomy (ELCA)-assisted PCI reduce major adverse cardiovascular events compared to PCI alone in patients with acute coronary syndrome?
Meta-Analysis
Does excimer laser coronary atherectomy (ELCA)-assisted PCI reduce major adverse cardiovascular events compared to PCI alone in patients with acute coronary syndrome?
In patients with ACS, ELCA-assisted PCI improves angiographic outcomes and reduces target lesion revascularization compared to PCI alone, but does not significantly reduce MACE or mortality.
Background Although excimer laser coronary atherectomy (ELCA) is used to reduce thrombus burden during percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS), its clinical benefit remains controversial. Previous studies have yielded inconsistent results, and current literature lacks quantitative synthesis. We aimed to evaluate the safety and efficacy of ELCA versus PCI alone in patients with ACS through a systematic review and meta‐analysis. Methods We searched PubMed, Web of Science, Scopus, Embase, and CENTRAL through December 2025 for randomized trials and observational studies comparing ELCA‐assisted PCI versus PCI alone in patients with ACS. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included other clinical endpoints (e.g., mortality, revascularization), procedural complications, and angiographic metrics. Risk ratios (RR) and mean differences (MDs) were pooled using fixed‐effects models, selected due to the limited number of included studies. Results Eleven studies were included in the qualitative review, while eight studies (one trial and seven observational studies) were included in the quantitative analysis. Regarding clinical outcomes, there were no significant differences in the primary endpoint of MACE (RR 0.90, 95% CI 0.62–1.29) or secondary endpoints such as cardiovascular death and myocardial infarction; however, ELCA significantly reduced target lesion revascularization (RR 0.06, 95% CI 0.01–0.48). Procedural complications, such as slow/no‐reflow and distal embolization, were comparable between groups. Angiographically, while most metrics (e.g., final TIMI flow and myocardial blush grade) showed no difference, ELCA significantly improved complete ST‐segment resolution (RR 1.37, 95% CI 1.06–1.77) and reduced percent diameter stenosis (MD −2.20, 95% CI −3.56 to −0.83). Conclusions ELCA‐assisted PCI appears safe and improves vessel patency, ST‐segment resolution, and target lesion revascularization rates; however, these mechanistic benefits did not translate into reduced MACE or mortality compared with standard PCI. Given the low certainty of the existing observational data and heterogeneity in angiographic outcomes, large‐scale randomized trials are required to confirm these findings and define the optimal target population.
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Darwish et al. (2026) conducted a meta-analysis in Acute coronary syndrome (ACS). Excimer laser coronary atherectomy (ELCA)-assisted PCI vs. Standard PCI alone was evaluated on Major adverse cardiovascular events (MACE) (RR 0.90, 95% CI 0.62-1.29). Excimer laser coronary atherectomy-assisted PCI did not significantly reduce major adverse cardiovascular events compared with standard PCI alone (RR 0.90; 95% CI 0.62-1.29).
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