Effectiveness of percutaneous laser revascularization therapy for refractory angina
Michael McGillion1, Allison Cook2, J Charles Victor3, Sandra Carroll2, Julie Weston1, Kevin Teoh4, Heather M Arthur2
1University of Toronto, 3Dalla Lana School of Public Health, Toronto, ON, Canada; 2McMaster University, Faculty of Health Sciences, Hamilton, ON, Canada; 4Hamilton Health Sciences, Hamilton, ON, Canada
Abstract: Refractory angina is a debilitating disease characterized by persistent cardiac pain resistant to all conventional treatments for coronary artery disease. Percutaneous myocardial laser revascularization (PMLR) has been proposed to improve symptoms in these patients. We used meta-analysis to assess the effectiveness of PMLR versus optimal medical therapy for improving angina symptoms, health-related quality of life (HRQL), and exercise performance; the impact on all-cause mortality was also examined. Seven trials, involving a total of 1,213 participants were included. Our primary analyses showed that at 12-month follow-up, those who had received PMLR had ≥2 Canadian Cardiovascular Society class angina symptom reductions, OR 2.13 (95% CI, 1.22 to 3.73), as well as improvements in aspects of HRQL including angina frequency, SMD = 0.29 (95% CI, 0.05 to 0.52), disease perception, SMD = 0.37 (95% CI, 0.14 to 0.61), and physical limitations, SMD = 0.29 (95% CI, 0.05 to 0.53). PMLR had no significant impact on all-cause mortality. Our secondary analyses, in which we considered data from one trial that featured a higher-dose laser group, yielded no significant overall impact of PMLR across outcomes. While PMLR may be effective for improving angina symptoms and related burden, further work is needed to clarify appropriate dose and impact on disease-specific mortality and adverse cardiac events.
Keywords: refractory angina, percutaneous laser revascularization, angina symptoms, health-related quality of life, meta-analysis
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