Transmyocardial Revascularization Endorsed For Refractory Angina

	September 10, 1999 - TMLR (Transmyocardial laser revascularization)
is an option for patients with angina that does not respond well to other
treatments, researchers say, based on the results of a rigorous prospective
study. "This study stands out because it used better scientific method than
other studies published so far," Dr. James Jones of Baylor College of
Medicine said.
	Dr. Jones and other investigators for the Angina Treatments-Lasers
and Normal Therapies in Comparison (ATLANTIC) study group recruited 182
patients with unresponsive angina for the study. The study group set strict
standards for judging exercise tolerance and other criteria, and about half
the candidates were excluded.
	Patients were given either TMLR plus continued drug therapy or drug
therapy alone. After 3, 6 and 12 months, the investigators reassessed the
patients' exercise tolerance and quality of life, and an independent
investigator evaluated angina severity.
	"The bottom line is that this therapy improves patients' symptoms
from ischemic heart disease, it improves their capacity for exercise and
quality of life, and it can be done with a very low mortality rate," Dr.
Jones said.
	At 12 months, ATLANTIC investigators found that exercise tolerance
had increased from baseline by 65 seconds in the TMLR group, while decreasing
46 seconds in patients receiving only medical therapy. The difference was
highly significant, they say in the September 11 issue of The Lancet.
	Angina scores decreased from 3-4 to 2 in 48% of patients who had
TMLR compared with only 14% of the drugs only group. Quality of life scores
increased significantly more in the TMLR group than in patients taking drugs
only. The mortality rate with TMLR was "around 1%" in this group, not much
different from other published results. This shows that TMLR can be done as
a relatively safe procedure for very ill patients."
	Patients who don't qualify for TMLR include those whose angina
is adequately controlled by current drugs or "who do not have ischemic heart
disease but have angina-like symptoms from other disorders," Dr. Jones
explained.

Lancet 1999;354:885-890