OBJECTIVE: Conflicting results exist on the therapeutic effects of percutaneous myocardial laser revascularization (PMR) in patients with refractory angina pectoris. This study assessed the effects of PMR on myocardial innervation and perfusion in patients with refractory angina pectoris. METHODS:Patients with refractory angina unsuitable for standard revascularization treatment (PTI and CABG) were randomly divided into medication plus PMR (PMR, n = 17) and medication group (M, n = 13). Coronary sinus noradrenaline (NE) and epinephrine (E) levels, heart rate variability (HRV), total ischemic burden (TIB), and ischemic ST segmental events (STI), myocardial perfusion were evaluated at pre-, immediately post and 12 months post treatment (mean followed up time = 11.6 +/- 4.9 months). RESULTS: In PMR group, one patient developed non-persistent ventricular tachycardia, 2 developed pericardial tamponade and another one patient developed heart failure at 24 h after operation. Coronary sinus NE and E were significantly lower 60 min post PMR compared to pre-PMR and HRV was significantly increased 24 h post PMR. One year post treatments, angina grade was significantly decreased in PMR (1.7 +/- 0.3) than that in M group (0.4 +/- 0.2, P < 0.05) while other parameters were similar between the groups. CONCLUSIONS:PMR induced an early transient denervation and decreased angina grade one year post treatment in patients with refractory angina.
RCT Entities:
OBJECTIVE: Conflicting results exist on the therapeutic effects of percutaneous myocardial laser revascularization (PMR) in patients with refractory angina pectoris. This study assessed the effects of PMR on myocardial innervation and perfusion in patients with refractory angina pectoris. METHODS:Patients with refractory angina unsuitable for standard revascularization treatment (PTI and CABG) were randomly divided into medication plus PMR (PMR, n = 17) and medication group (M, n = 13). Coronary sinus noradrenaline (NE) and epinephrine (E) levels, heart rate variability (HRV), total ischemic burden (TIB), and ischemic ST segmental events (STI), myocardial perfusion were evaluated at pre-, immediately post and 12 months post treatment (mean followed up time = 11.6 +/- 4.9 months). RESULTS: In PMR group, one patient developed non-persistent ventricular tachycardia, 2 developed pericardial tamponade and another one patient developed heart failure at 24 h after operation. Coronary sinus NE and E were significantly lower 60 min post PMR compared to pre-PMR and HRV was significantly increased 24 h post PMR. One year post treatments, angina grade was significantly decreased in PMR (1.7 +/- 0.3) than that in M group (0.4 +/- 0.2, P < 0.05) while other parameters were similar between the groups. CONCLUSIONS: PMR induced an early transient denervation and decreased angina grade one year post treatment in patients with refractory angina.