Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial

Citation
Pm. Schofield et al., Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial, LANCET, 353(9152), 1999, pp. 519-524
Citations number
26
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
LANCET
ISSN journal
01406736 → ACNP
Volume
353
Issue
9152
Year of publication
1999
Pages
519 - 524
Database
ISI
SICI code
0140-6736(19990213)353:9152<519:TLRIPW>2.0.ZU;2-1
Abstract
Background Transmyocardial laser revascularisation (TMLR) is used to treat patients with refractory angina due to severe coronary artery disease, not suitable for conventional revascularisation. We aimed in a randomised contr olled trial to assess the effectiveness of TMLR compared with medical manag ement. Methods 188 patients with refractory angina were randomly assigned TMLR plu s normal medication or medical management alone. At 3 months, 6 months, and 12 months after surgery (TMLR) or initial assessment (medical management) we assessed exercise capacity with the treadmill test and the 12 min walk. Findings Mean treadmill exercise time, adjusted for baseline values, was 40 s (95% CI -15 to 94) longer in the TMLR group than in the medical-manageme nt group at 12 months (p = 0.152). Mean 12 min walk distance was 33 m (-7 t o 74) further in TMLR patients than medical-management patients (p = 0.108) at 12 months. The differences were not significant or clinically important . Perioperative mortality was 5%. Survival at 12 months was 89% (83-96) in the TMLR group and 96% (92-100) in the medical-management group (p = 0.14). Canadian Cardiovascular Society score for angina had decreased by at least two classes in 25% of TMLR and 4% of medical-management patients at 12 mon ths (p < 0.001). Interpretation Our findings show that the adoption of TMLR cannot be advoca ted. Further research may be appropriate to assess any potential benefit fo r sicker patients.