WESTPORT, CT (Reuters Health) – Transmyocardial carbon dioxide laser revascularization dramatically improves the health status of patients with severe, symptomatic, inoperable coronary artery disease (CAD).
Dr. John A. Spertus, from the University of Missouri at Kansas City, and colleagues randomized 197 patients with severe inoperable CAD to undergo transmyocardial revascularization or continued medical therapy. Fifty-nine of the 99 patients in the medical group subsequently underwent transmyocardial revascularization.
Based on intention-to-treat analysis, transmyocardial revascularization was associated with significantly better angina control than was continued medical therapy. Transmyocardial revascularization also resulted in significant improvements in physical limitations and quality of life, the researchers note. The benefits appeared to be even greater when cross-over patients were excluded from the analysis.
The effects of transmyocardial revascularization on health status were first noted 3 months after treatment and persisted throughout the 1-year follow-up period, the investigators state in the October 1st issue of The American Journal of Medicine.
While there was no survival benefit associated with transmyocardial revascularization, the findings indicate the procedure has numerous palliative effects in patients with severe inoperable CAD, the authors note.
In a related editorial, Dr. William S. Weintraub, from the Emory Center for Outcomes Research in Atlanta, comments that lack of blinding, a substantial placebo effect, and a short follow-up period may have contributed to the current results.
"Because a sham operation to enable a blinded trial would probably not be ethical, randomized trials of laser versus no laser as an adjunct to coronary surgery are needed," Dr. Weintraub notes. "In the absence of convincing clinical trials, we will have to settle for something a bit short of that."
Am J Med 2001;111:341-348,405-406.
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