Effectiveness of percutaneous laser revascularization therapy for refractory angina

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.

Stimulation Effect of Low Level Laser Therapy on Sciatic Nerve Regeneration in Rat

“…It has been previously shown that laser therapy can increase blood flow, revascularization [34][35][36] and generate healing to an injured area. 37 This is believed to be the result of release of angiogenic factors such as vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), type I collagen (Col-I) and inducible nitric oxide synthase (iNOS) that play key roles in angiogenesis, [38][39][40][41] subsequently assisting and accelerating nerve regeneration.…”

Impact of self-management interventions on stable angina symptoms and health-related quality of life: a meta-analysis

“…Four reviewers (MM, SOM, SC, NJ) participated in independent quality assessment and extraction of process and outcome data from each new trial according to a standardized extraction format we have used in other reviews [ 22 - 24 ]. Methodological quality of included trials was appraised via standard Cochrane criteria for risk of bias assessment [ 25 ] including generation of randomization sequence; allocation concealment; blinding of participants, personnel and outcome assessors (detection bias); standardized intervention delivery and presence of co-intervention (performance bias); reliability and validity of measurement instruments (insensitive measurement bias); response rate (RR) and attrition (attrition bias); and selective reporting (reporting bias).…”

Neue US-Hypertonie-Leitlinien lockern Therapieziele deutlich

“…Four reviewers (MM, SOM, SC, NJ) participated in independent quality assessment and extraction of process and outcome data from each new trial according to a standardized extraction format we have used in other reviews [22][23][24]. Methodological quality of included trials was appraised via standard Cochrane criteria for risk of bias assessment [25] including generation of randomization sequence; allocation concealment; blinding of participants, personnel and outcome assessors (detection bias); standardized intervention delivery and presence of co-intervention (performance bias); reliability and validity of measurement instruments (insensitive measurement bias); response rate (RR) and attrition (attrition bias); and selective reporting (reporting bias).…”