Therapy

Offer transmyocardial laser revascularisation. ^a  

Why?

• Patients unfit for angioplasty or CABG with refractory angina who undergo transmyocardial laser revascularisation compared with optimal medical therapy have an improvement in symptoms ^a , fewer cardiac events ^a   and fewer admissions to hospital with cardiac problems. ^a  
• However more patients develop heart failure.  ^a
• There is no clear difference in mortality.  ^a

Transmyocardial revascularisation improves symptoms and reduces cardiac events and hospital admissions in refractory cases

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
refractory angina, unfit for PTCA or CABG a	transmyocardial revascularisation	optimal medical therapy	improvement of 2 or more functional classes at at 12 months	0%		3 (2 to 4)
refractory angina, unfit for PTCA or CABG a	transmyocardial revascularisation	optimal medical therapy	hospital admission with cardiac problem at at 12 months	67%	33% (17% to 46%)	4 (3 to 6)
	transmyocardial revascularisation	optimal medical therapy	cardiac event at at 12 months	69%	33% (17% to 46%)	4 (3 to 9)
refractory angina, unfit for PTCA or CABG a	transmyocardial revascularisation	optimal medical therapy	heart failure at 12 months	11%	-150% (-380% to -25%)	-6 (-20 to -4)