Results of transmyocardial laser revascularization in non-revascularizable coronary artery disease after 3 years follow-up

Background Transmyocardial laser revascularization is a new therapeutic option for end-stage coronary artery disease if no other cardiological or cardiosurgical intervention is possible. Data are few on how patients fare after more than 1 year follow-up. Methods and Results From a total of 157 patients who were suggested for transmyocardial laser therapy in the years 1995–1997, 126 were judged to have non-revascularizable coronary artery disease (mean age 61·9±14 years, 80% men, mean left ventricular ejection fraction 46·2±17·1%). Sixty-six patients had a good clinical response to intensification of the antianginal therapy and were therefore treated further medically. In 60 patients with refractory angina, sole transmyocardial laser revascularization without cardiopulmonary bypass or additional grafts was performed. The transmyocardial laser revascularization group was 32% female; 78·3% patients had had bypass operations; the mean left ventricular ejection fraction was 53·6±15%. Eighty five percent of the transmyocardial laser revascularization patients had demonstrable ischaemic regions, as visualized by dipyridamol–MIBI scintigraphy. The percentage of patients with some hibernating myocardium in positron emission tomography studies was 70%. Good early relief of angina symptoms was experienced by patients who had undergone laser treatment. After 3 months the Canadian Cardiovascular Society class fell from 3·31±0·51 to 1·84±0·77 in 49 patients (P