title: Percutaneous myocardial laser revascularization in patients with refractory angina pectoris.
abstract: This study aimed to determine the safety and efficacy of percutaneous myocardial laser revascularization (PMLR). Seventy-three patients with stable angina pectoris (class III or IV) who were unsuitable for conventional revascularization and had evidence of reversible ischemia by thallium-201 scintigraphy, ejection fraction of > or =25%, and myocardial wall thickness > or =8 mm were randomized to optimal medical therapy alone (n = 37) or PMLR with optimal medical therapy (n = 36). Patients were followed up at 3, 6, and 12 months. The primary end point was exercise time. Secondary end points included angina scores, left ventricular ejection fraction, quality of life, changes in medical therapy, and hospitalizations. All 36 patients randomized to PMLR underwent the procedure successfully with no periprocedure deaths. One patient developed sustained ventricular tachycardia that required electrical cardioversion, and 1 patient developed cardiac tamponade that required surgical drainage. At 12 months, exercise times improved by 109 seconds in the PMLR group but decreased by 62 seconds in the control group (p <0.01). Angina scores improved by 2 classes in 36% of PMLR-treated patients at 12 months compared with 0% of the control patients (p <0.01). We conclude that PMLR is a relatively safe procedure that provides patients with symptomatic angina relief and improvement in exercise capacity and quality of life.
authors.affiliation: Papworth Hospital, Cambridge, United Kingdom. tim_gray@hotmail.com
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Gray
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Burns
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Clarke
authors.forename: Sue
authors.initials: S
authors.lastname: Tait
authors.forename: Linda D
authors.initials: LD
authors.lastname: Sharples
authors.forename: Noreen
authors.initials: N
authors.lastname: Caine
authors.forename: Peter M
authors.initials: PM
authors.lastname: Schofield
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D016342:Angioplasty, Laser / Q000009:adverse effects*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D011788:Quality of Life; D011877:Radionuclide Imaging; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology