Transmyocardial laser revascularisation in patients with refractory angina: a randomised controlled trial

Lancet. 1999 Feb 13;353(9152):519-24. doi: 10.1016/s0140-6736(98)11478-2.


Background: Transmyocardial laser revascularisation (TMLR) is used to treat patients with refractory angina due to severe coronary artery disease, not suitable for conventional revascularisation. We aimed in a randomised controlled trial to assess the effectiveness of TMLR compared with medical management.

Methods: 188 patients with refractory angina were randomly assigned TMLR plus normal medication or medical management alone. At 3 months, 6 months, and 12 months after surgery (TMLR) or initial assessment (medical management) we assessed exercise capacity with the treadmill test and the 12 min walk.

Findings: Mean treadmill exercise time, adjusted for baseline values, was 40 s (95% CI -15 to 94) longer in the TMLR group than in the medical-management group at 12 months (p=0.152). Mean 12 min walk distance was 33 m (-7 to 74) further in TMLR patients than medical-management patients (p=0.108) at 12 months. The differences were not significant or clinically important. Perioperative mortality was 5%. Survival at 12 months was 89% (83-96) in the TMLR group and 96% (92-100) in the medical-management group (p=0.14). Canadian Cardiovascular Society score for angina had decreased by at least two classes in 25% of TMLR and 4% of medical-management patients at 12 months (p<0.001).

Interpretation: Our findings show that the adoption of TMLR cannot be advocated. Further research may be appropriate to assess any potential benefit for sicker patients.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angina Pectoris / diagnosis
  • Angina Pectoris / epidemiology
  • Angina Pectoris / surgery*
  • Angina Pectoris / therapy
  • Exercise Test
  • Exercise Tolerance
  • Female
  • Humans
  • Laser Therapy*
  • Male
  • Middle Aged
  • Myocardial Revascularization / methods*
  • Survival Rate
  • Treatment Outcome