Sustained angina relief 5 years after transmyocardial laser revascularization with a CO₂ laser

Background - Although transmyocardial laser revascularization (TMR) has provided symptomatic relief of angina over the short term, the long-term efficacy of the procedure is unknown. Angina symptoms as assessed independently by angina class and the Seattle Angina Questionnaire (SAQ) were prospectively collected up to 7 years after TMR. Methods - Seventy-eight patients with severe angina not amenable to conventional revascularization were treated with a CO₂ laser. Their mean age was 61±10 years at the time of treatment. Preoperatively, 66% had unstable angina, 73% had had ≥1 myocardial infarction, 93% had undergone ≥1 CABG, 42% had ≥ PTCA, 76% were in angina class IV, and 24% were in angina class III. Their average pre-TMR angina class was 3.7±0.4. Results - After an average of 5 years (and up to 7 years) of follow-up, the average angina class was significantly improved to 1.6±1 (P=0.0001). This was unchanged from the 1.5±1 average angina class at 1 year postoperatively (P=NS). There was a marked redistribution according to angina class, with 81% of the patients in class II or better, and 17% of the patients had no angina 5 years after TMR. A decrease of ≥2 angina classes was considered significant, and by this criterion, 68% of the patients had successful long-term angina relief. The angina class results were further confirmed with the SAQ; 5-year SAQ scores revealed an average improvement of 170% over the baseline results. Conclusions - The long-term efficacy of TMR persists for ≥5 years. TMR with CO₂ laser as sole therapy for severe disabling angina provides significant long-term angina relief.