The PACIFIC Trial

	PMR (Percutaneous myocardial revascularization) is a new strategy
for managing patients with severe CAD (coronary artery disease) that does
not respond to drug therapy. In the growing population of patients for
whom more angioplasty or bypass surgery is not an option, PMR may provide
a way to treat ischemia. Dr. Stephen Oesterle presented the 6-month
results of the Potential Angina Class Improvement From Intramyocardial
Channels (PACIFIC) Trial.
	Patients: 221 patients with class 3-4 angina were given either
PMR plus drug therapy, or anti-angina drug therapy. Patients with an EF
less than 30%, Q-wave heart attack within 3 months, non-Q-wave heart
attack within 6 weeks, unstable angina within 2 weeks, or severe aortic
stenosis were not allowed in the study. Patients getting PMR had 10-15
channels made via a YAG laser used through a catheter via the femoral
artery (groin). The patients were followed for one year with the primary
endpoints being angina score and exercise tolerance.
	The average age for both groups was 62 years; 86% were male.
48% of the PMR group had diabetes, as did 41% of the control group.
67% of the PMR group had high BP, as did 75% of controls. Prior heart
attack had happened in 65% of the PMR group and 68% of control patients.
Prior invasive procedures or bypass surgery had been done in 86% of the
PMR patients and 96% of controls.
	Results: At 3 month follow-up, 46% of the patients getting PMR
had an improvement of at least 2 angina classes, vs 6% of patients treated
with drugs alone. These results were maintained at 6 months of follow-up.
	Exercise duration also improved in the PMR group. At 3 months,
the PMR group had a 25% increase in treadmill exercise time. At 6
months, the PMR group exercised 30% longer compared to baseline. The
control patients had a 5% improvement in exercise duration at 3 and 6
months.
	After 6 months of follow-up, 8 deaths (7%) occurred in the PMR
group, and 2 (2%) in the control group. There were no deaths during the
procedure itself, no heart attacks and no strokes. One patient developed
complete heart block and required a permanent pacemaker implantat.
	Conclusions: After reviewing the 6-month follow-up of the PACIFIC
trial, it seems that PMR is safe and has acceptable complication rates and
mortality. Patients assigned to PMR had a significant improvement in
angina scores and had a significant increase in treadmill exercise time.
We await the 12-month follow-up data. PMR may be a promising strategy to
manage patients with angine not responding to drugs, who are not candidates
for further angioplasty or bypass surgery.