title: Transmyocardial revascularization using an XeCl excimer laser: results of a randomized trial.
abstract: 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.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Jos A P
authors.initials: JA
authors.lastname: van der Sloot
authors.forename: Menno
authors.initials: M
authors.lastname: Huikeshoven
authors.forename: Raymond
authors.initials: R
authors.lastname: Tukkie
authors.forename: Hein J
authors.initials: HJ
authors.lastname: Verberne
authors.forename: Jan
authors.initials: J
authors.lastname: van der Meulen
authors.forename: Berthe L F
authors.initials: BL
authors.lastname: van Eck-Smit
authors.forename: Martin J C
authors.initials: MJ
authors.lastname: van Gemert
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Johan F
authors.initials: JF
authors.lastname: Beek
mesh_terms: 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
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D009566:Nitrates