Sustained angina relief 5 years after transmyocardial laser revascularization with a CO(2) laser.
BACKGROUND
Although transmyocardial laser revascularization (TMR) has provided symptomatic relief of angina over the short term, the long-term efficacy of the procedure is unknown. Angina symptoms as assessed independently by angina class and the Seattle Angina Questionnaire (SAQ) were prospectively collected up to 7 years after TMR.


METHODS
Seventy-eight patients with severe angina not amenable to conventional revascularization were treated with a CO(2) laser. Their mean age was 61+/-10 years at the time of treatment. Preoperatively, 66% had unstable angina, 73% had had >/=1 myocardial infarction, 93% had undergone >/=1 CABG, 42% had >/=1 PTCA, 76% were in angina class IV, and 24% were in angina class III. Their average pre-TMR angina class was 3.7+/-0.4.


RESULTS
After an average of 5 years (and up to 7 years) of follow-up, the average angina class was significantly improved to 1.6+/-1 (P=0.0001). This was unchanged from the 1.5+/-1 average angina class at 1 year postoperatively (P=NS). There was a marked redistribution according to angina class, with 81% of the patients in class II or better, and 17% of the patients had no angina 5 years after TMR. A decrease of >/=2 angina classes was considered significant, and by this criterion, 68% of the patients had successful long-term angina relief. The angina class results were further confirmed with the SAQ; 5-year SAQ scores revealed an average improvement of 170% over the baseline results.


CONCLUSIONS
The long-term efficacy of TMR persists for >/=5 years. TMR with CO(2) laser as sole therapy for severe disabling angina provides significant long-term angina relief.
Horvath
K A
KA
Northwestern University Medical School, Chicago, Illinois, USA. khorvath@nmh.org
Aranki
S F
SF
Cohn
L H
LH
March
R J
RJ
Frazier
O H
OH
Kadipasaoglu
K A
KA
Boyce
S W
SW
Lytle
B W
BW
Landolfo
K P
KP
Lowe
J E
JE
Hattler
B
B
Griffith
B P
BP
Lansing
A M
AM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000145:classification / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000295:instrumentation* / Q000379:methods*; D011184:Postoperative Period; D012074:Remission Induction; D011795:Surveys and Questionnaires; D013995:Time; D016896:Treatment Outcome