Results of prospective randomized controlled trials of transmyocardial laser revascularization

Over 6,000 patients worldwide have undergone transmyocardial laser revascularization (TMR) for the treatment of myocardial ischemia due to end-stage coronary artery disease since 1990. Four prospective randomized controlled trials have reported their results in comparing TMR to maximum medical therapy. All of the trials demonstrated that TMR provided significant relief of angina when compared to medical management. Additional objective data in the form of exercise tolerance and myocardial perfusion scanning was used to support the symptomatic improvement. Recent reports of the failure of percutaneous transmyocardial laser revascularization (PMR) to provide angina relief greater than that seen in a placebo group underscore the need for better understanding of TMR. While all of these trials are similar, they are not identical and this review provides an update and comparison of the results.