Usefulness and safety of percutaneous myocardial laser revascularization for refractory angina pectoris☆
Section snippets
Participants
After referral for possible laser revascularization, consenting patients were assessed for suitability at the 2 participating institutions (Haukeland Hospital, Bergen, Norway, and Ulleval University Hospital, Oslo, Norway). The following criteria were necessary for inclusion in the study: stable Canadian Cardiovascular Society (CCS) class III or IV angina refractory to maximally tolerated doses of ≥2 antianginal medications; evidence of reversible myocardial ischemia on exercise testing or
Patient characteristics
Patient follow-up is shown in Figure 1; 82 patients were randomized (PMLR n = 40, sham n = 42). All baseline characteristics (Table 1) were similar between groups.
Procedural outcomes
In each group, comparable channel placements were made (PMLR 19 ± 4.5 vs sham 20 ± 3.6; p = 0.30) over comparable procedure durations (PMLR 36 ± 16 minutes vs sham 37 ± 12 minutes; p = 0.66). The primary target region within the left ventricle was the lateral wall (n = 67; 82%), followed by the inferior (n = 51; 62%) and anterior (n
Discussion
Surgical laser revascularization was developed for the treatment of patients unsuitable for conventional therapies due to diffuse disease5 and has been evaluated in 5 prospective, randomized trials against optimal medical therapy.6, 7, 8, 9, 10 Results at 1 year show superior angina relief and improved event-free survival/quality of life, yet with equivocal results in perfusion improvement. PMLR was developed as a less invasive alternative11 to avoid general anesthesia/thoracotomy with the
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2016, Annals of Medicine and SurgeryCitation Excerpt :5) The presence of inter-study variability between sham and not sham studies was not ascribable to mean or median age of patients but possibly to other factors. 6) The absence of psychological and psychiatric profile that is relevant for studies were the placebo effect have to be evaluated represents a very important confounding factor [10,22,24–73,78,79]. 7) A percentage of 5% of participants lost to the follow-up has been extracted from 30 on the 52 studies examined (ref.).
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This study was supported by a grant from The Bergen Heart Foundation, Bergen, Norway.