Catheter laser procedure and heart medicine effective

November 15, 2000

Rush-Presbyterian-St. Luke's Medical Center sole Chicago medical center in trial

Using a catheter to deliver laser therapy and medication for chest pain associated with heart disease is more effective than medication alone, according to a study published in the Lancet on November, 2000. Researchers from several medical centers, including Chicago's Rush-Presbyterian-St. Luke's Medical Center, tested percutaneous transmyocardial laser revascularization (PTMR) to determine if it, in combination with medication, was more effective than medication such as calcium channel blockers for treating chest pain. Candidates for PTMR have severe chest pain and could not receive angioplasty or bypass surgery.

During the procedure, a cardiologist makes a small puncture near the patient's groin and threads a catheter from the femoral artery into the heart's left ventricle. The holmium:YAG laser rests at the end of the catheter. Using fluoroscopy -- a monitoring device used to show the exact location of the end of the catheter -- the physician positions the catheter near the target heart region.

Laser energy is used to make a varying number of channels approximately one-quarter of an inch deep in the heart muscle. The laser is timed to fire at the end of the systolic phase of the heart's contraction when the heart wall is thickest. Dr. Gary Schaer, director of the Cardiac Catheterization Laboratories at Rush-Presbyterian-St. Luke's Medical Center, said PTMR stimulates the growth of new blood vessels, which increases circulation and blood flow into the heart and relieve the pain of angina.

The Lancet study included 221 subjects with severe chest pain from 13 centers -- 100 subjects were randomly assigned to receive PTMR with a holmium:YAG laser and continued medication while 111 received medication alone. Baseline evaluation included angina class, exercise tolerance, Seattle Angina Questionnaire (SAQ), and a stress test. Subjects were re-evaluated at three, six, and 12 months after randomization, including blinded angina assessment after 12 months.

After 12 months in the study, patients who received the PTMR and medication showed an 89-second improvement (without chest pain) over their baseline treadmill test compared to only 12 seconds for the medication only group. More than a third (34.1 percent) of the PTMR patient group also reported their chest pain decreased from severe categories to more moderate while only 13 percent of the mediation-only group said their chest pain improved. Total one-year mortality was 7.3% with PTMR group compared to 2.7% with medication only group.

"Although there is speculation about the mechanism of action, this investigation suggests that PTMR provides clinical benefits for patients who are not candidates for angioplasty or bypass surgery and who could not get relief from their chest pain using medications," said Dr. Jeffrey Snell, associate director of interventional cardiology at Rush.

According to the American Heart Association, more than seven million people in the United States suffer from angina and about 350,000 new cases of angina are diagnosed each year. Angina occurs when the heart is not getting enough oxygen. A person with angina may feel as if his or her chest is being squeezed, or may feel a sharp, burning or cramping pain that may spread to the neck, jaw, throat, shoulder, upper back or arms. Some patients with angina are in severe, constant pain-- often, just walking across a room becomes difficult.
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Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about two million people through its outpatient facilities and five member hospitals.

Rush University Medical Center

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