Transmyocardial revascularization using an XeCl excimer laser: results of a randomized trial.
BACKGROUND
CO2 and holmium:yttrium aluminum garnet (YAG) transmyocardial laser revascularization (TMLR) are used to treat patients with refractory angina. A randomized trial to investigate the efficacy and safety of XeCl excimer TMLR was performed.


METHODS
Thirty patients with refractory angina were randomized in pairs to excimer TMLR or maximal medication. We assessed angina, quality of life (QOL), exercise time, myocardial perfusion, and ventricular wall motion at base line and at 3, 6, and 12 months after TMLR.


RESULTS
TMLR patients manifested a significantly better outcome with respect to angina class and quality of life. One TMLR patient died perioperatively versus none in the control group. After TMLR angina decreased from class 3.8 +/- 0.4 at base line to 1.9 +/- 0.9 at 12 months versus 3.9 +/- 0.3 to 3.7 +/- 0.6 in the control group, respectively (p = 0.000001). At 12 months a decrease of greater than or equal to two angina classes was indicated in 11 out of 14 TMLR patients versus none in the control group (p = 0.00001). Improved myocardial perfusion or exercise time was not indicated despite a small decrease in reversible wall motion abnormality score.


CONCLUSIONS
Excimer TMLR significantly relieves angina and improves QOL without evidence of improved cardiac perfusion or function.
van der Sloot
Jos A P
JA
Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Huikeshoven
Menno
M
Tukkie
Raymond
R
Verberne
Hein J
HJ
van der Meulen
Jan
J
van Eck-Smit
Berthe L F
BL
van Gemert
Martin J C
MJ
Tijssen
Jan G P
JG
Beek
Johan F
JF
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000787:Angina Pectoris / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D009566:Nitrates / Q000627:therapeutic use; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011788:Quality of Life; D013318:Stroke Volume; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D009566:Nitrates