Results of clinical trials of transmyocardial laser revascularization versus medical management for end-stage coronary disease

Background Data: Over 5,000 patients worldwide have undergone transmyocardial laser revascularization (TMR) since 1990 for the treatment of myocardial ischemia due to end-stage coronary artery disease. Recently, four prospective randomized controlled clinical trials have reported their results in comparing TMR to maximal medical therapy. The purpose of this review is to provide an update and comparison of the results of these trials. Methods: Patients with severe angina were randomized to treatment by laser TMR (carbon dioxide or holmium YAG) or continuing on maximum medical therapy. All patients were followed for a year and had reassessment of angina class and quality of life at that time. Results: All of the trials demonstrated that TMR provided significant relief of angina when compared to medical management. Additional objective data in the form of exercise tolerance and myocardial perfusion scanning was used to support the symptomatic improvement. Conclusion: Symptomatic improvement is seen for patients with severe diffuse coronary artery disease treated by TMR.