Transmyocardial revascularization with CO2 laser in patients with refractory angina pectoris - Clinical results from the Norwegian randomized trial

OBJECTIVES The purpose of the study was to evaluate clinical effects, exerc ise performance and effect on maximal oxygen consumption (MVO2) of transmyo cardial revascularization with CO2-laser (TMR) in patients with refractory angina pectoris. BACKGROUND Transmyocardial laser revascularization is a new method to treat patients with refractory angina pectoris not eligible for conventional rev ascularization. Few randomized studies comparing TMR with conventional trea tment have been published. METHODS One hundred patients with refractory angina not eligible for conven tional revascularization were block-randomized in a 1:1 ratio to receive co ntinued optimal medical treatment (MT) or TMR in addition to MT. The patien ts were evaluated at baseline and at three and 12 months with end points to symptoms, exercise capacity and MVO2. RESULTS Transmyocardial laser revascularization resulted in significant rel ief in angina symptoms after three and 12 months compared to baseline. Time to chest pain during exercise increased from baseline by 78 s after three months (p = NS) and 66 s (p < 0.01) after 12 months ill the TMR group, wher eas total exercise time and MVO2 were unchanged. No significant changes wer e observed in the MT group. Perioperative mortality was 4%. One year mortal ity was 12% in the TMR group and 8% in the MT group (p = NS.) CONCLUSIONS Transmyocardial laser revascularization was performed with low perioperative mortality and caused significant symptomatic improvement, but no improvement in exercise capacity. (J Am Coll Cardiol 2000;35:1170-7) (C ) 2000 by the American College of Cardiology.