Long-term results following percutaneous myocardial laser therapy.
OBJECTIVE
The usefulness and safety of percutaneous myocardial laser therapy in selected patients have been identified in previous 1-year randomized trial reports, including that from a double-blind, sham-controlled trial we independently conducted. We aimed to determine whether the 1-year effects are maintained through a long-term, longitudinal follow-up.


METHODS
Patients (n=77) with chronic, stable, medically refractory angina (class III or IV) not amenable to conventional revascularization and with evidence of reversible ischemia, ejection fraction > or =25%, and myocardial wall thickness > or =8 mm were treated with percutaneous myocardial laser. After the 1-year follow-up and disclosure of all randomized assignments as prespecified in the respective study protocol, patients were followed up longitudinally for a mean of 3 years for angina class, left ventricular ejection fraction, medication usage, and adverse events.


RESULTS
No procedural mortality, myocardial infarction, or cerebral embolism occurred. Pericardiocentesis was required in two patients (2.6%). Cardiac event-free survival was 88% at 1 year and 66% at late follow-up. Mean Canadian Cardiovascular Society angina class was significantly improved from baseline (3.2+/-0.4) at 1 year (2.2+/-1.1, P<0.001) and at a mean of 3 years (1.9+/-1.2, P<0.001). Nitrate usage was significantly reduced at late follow-up; however, ejection fraction did not change over time. In a multivariate analysis, angina improvement at 1 year was found to be a significant independent predictor of both survival and angina improvement at late follow-up.


CONCLUSIONS
We conclude that percutaneous myocardial laser therapy in selected patients with severe, medically refractory angina not treatable with conventional revascularization induces significant and sustained symptomatic benefit.
Salem
Mohamed
M
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Rotevatn
Svein
S
Nordrehaug
Jan Erik
JE
D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D017222:Angioplasty, Balloon, Laser-Assisted; D016342:Angioplasty, Laser; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D028022:Low-Level Light Therapy; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D016277:Ventricular Function, Left