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Titolo:
Percutaneous transmyocardial laser revascularisation for severe angina: the PACIFIC randomised trial
Autore:
Oesterle, SN; Sanborn, TA; Ali, N; Resar, J; Ramee, SR; Heuser, R; Dean, L; Knopf, W; Schofield, P; Schaer, GL; Reeder, G; Masden, R; Yeung, AC; Burkhoff, D;
Indirizzi:
Massachusetts Gen Hosp, Div Cardiol, Boston, MA 02114 USA Massachusetts Gen Hosp Boston MA USA 02114 Cardiol, Boston, MA 02114 USA New York Presbyterian Hosp, New York, NY USA New York Presbyterian Hosp New York NY USA terian Hosp, New York, NY USA Baylor Univ VA Hosp, Houston, TX USA Baylor Univ VA Hosp Houston TX USABaylor Univ VA Hosp, Houston, TX USA Johns Hopkins Hosp, Baltimore, MD 21287 USA Johns Hopkins Hosp Baltimore MD USA 21287 s Hosp, Baltimore, MD 21287 USA Oschner Clin, New Orleans, LA USA Oschner Clin New Orleans LA USAOschner Clin, New Orleans, LA USA Columbia Hosp, Phoenix, AZ USA Columbia Hosp Phoenix AZ USAColumbia Hosp, Phoenix, AZ USA Univ Alabama, Birmingham, AL USA Univ Alabama Birmingham AL USAUniv Alabama, Birmingham, AL USA St Josephs Hosp, Atlanta, GA USA St Josephs Hosp Atlanta GA USASt Josephs Hosp, Atlanta, GA USA Papworth Hosp, Cambridge CB3 8RE, England Papworth Hosp Cambridge England CB3 8RE Hosp, Cambridge CB3 8RE, England Rush Presbyterian St Lukes Med Ctr, Chicago, IL 60612 USA Rush Presbyterian St Lukes Med Ctr Chicago IL USA 60612 ago, IL 60612 USA Mayo Clin, Rochester, MN USA Mayo Clin Rochester MN USAMayo Clin, Rochester, MN USA Jewish Hosp, Louisville, KY USA Jewish Hosp Louisville KY USAJewish Hosp, Louisville, KY USA Stanford Univ, Med Ctr, Stanford, CA 94305 USA Stanford Univ Stanford CA USA 94305 Univ, Med Ctr, Stanford, CA 94305 USA Columbia Univ, New York, NY USA Columbia Univ New York NY USAColumbia Univ, New York, NY USA
Titolo Testata:
LANCET
fascicolo: 9243, volume: 356, anno: 2000,
pagine: 1705 - 1710
SICI:
0140-6736(20001118)356:9243<1705:PTLRFS>2.0.ZU;2-A
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; MYOCARDIAL REVASCULARIZATION; REFRACTORY ANGINA; MEDICAL THERAPY; BLOOD-FLOW; ANGIOGENESIS; PECTORIS; CHANNELS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
20
Recensione:
Indirizzi per estratti:
Indirizzo: Oesterle, SN Massachusetts Gen Hosp, Div Cardiol, Bulfinch 105,55 Fruit St, Boston, MA 02114 USA Massachusetts Gen Hosp Bulfinch 105,55 Fruit St Boston MA USA 02114
Citazione:
S.N. Oesterle et al., "Percutaneous transmyocardial laser revascularisation for severe angina: the PACIFIC randomised trial", LANCET, 356(9243), 2000, pp. 1705-1710

Abstract

Background Percutaneous transmyocardial laser revascularisation (PTMR) is a proposed catheter-based therapy for refractory angina pectoris when bypass surgery or angioplasty is not possible. We undertook a randomised trial to assess the safety and efficacy of this technique. Methods 221 patients with reversible ischaemia of Canadian Cardiovascular Society angina class 111 (61%) or IV (39%) and incomplete response to othertherapies were recruited from 13 centres. Patients were randomly assigned PTMR with a holmium:YAG laser plus continued medical treatment (n=110) or continued medical treatment only (n=111). The primary endpoint was the exercise tolerance at 12 months. Analyses were by intention to treat. Findings 11 patients died and 19 withdrew; 92 PTMR-group and 99 medical-treatment-group patients completed the study. Exercise tolerance at 12 monthshad increased by a median of 89.0 s (IQR -15 to 183) with PTMR compared with 12.5 s (-67 to 125) with medical treatment only (p=0.008). On masked assessment, angina class was II or lower in 34.1% of PTMR patients compared with 13.0% of those medically treated. All indices of the Seattle angina questionnaire improved more with PTMR than with medical care only. By 12 monthsthere had been eight deaths in the PTMR group and three in the medical treatment group, with similar survival in the two groups. Interpretation PTMR was associated with increased exercise tolerance time,low morbidity, lower angina scores assessed by masked reviewers, and improved quality of life. Although there is controversy about the mechanism of action, and the contribution of the placebo effect cannot be quantified, this unmasked study suggests that this palliative procedure provides some clinical benefits in the defined population of patients.

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Documento generato il 26/09/20 alle ore 01:50:38