Clinical outcomes of excimer laser coronary atherectomy (ELCA) in percutaneous coronary intervention: A 10-year single-centre experience.

BACKGROUND: Excimer laser coronary atherectomy (ELCA) is used in complex percutaneous coronary intervention (PCI), but contemporary long-term data across indications remain limited. METHODS: We retrospectively included consecutive adults undergoing ELCA-assisted PCI at a tertiary centre from 2015 to 2025. Procedural and in-hospital outcomes were assessed in all patients. Long-term time-to-first major adverse cardiac events (MACE; target-vessel revascularisation, non-fatal myocardial infarction, or all-cause death) were evaluated among patients discharged alive. RESULTS: 62 patients were included (median age, 69.5 years [IQR 58-76]; 27.4% female). Calcified balloon-uncrossable lesions (33.9%) and in-stent restenosis (ISR; 30.6%) were the most common indications; 40.3% presented with non-ST-elevation ACS and 12.9% with STEMI. Technical success was achieved in 91.9%; 80.6% also met a composite of freedom from complications and in-hospital death. Complications occurred in 6 patients (9.7%) and in-hospital death in 4 (6.5%). Among 58 patients discharged alive, 24 (41.4%) experienced MACE over a median 49 months [IQR 8-99], driven by target-vessel revascularisation (29.3%); Kaplan-Meier event-free survival was 93.1% at 30 days, 81.8% at one year, 73.2% at two years and 60.0% at five years. In multivariable analysis, prior CABG (HR 9.64, 95% CI 3.43-27.10), diabetes (HR 3.76, 1.52-9.32) and ISR (HR 4.25, 1.48-12.19) were independent predictors of MACE. CONCLUSIONS: In this 10-year single-centre series, ELCA-assisted PCI achieved high technical success with acceptable in-hospital outcomes in a high-risk cohort, although long-term MACE remained frequent, driven predominantly by target-vessel revascularisation.