Objective

A best evidence topic (BestBET) was written according to a structured protocol. The clinical question addressed was: In patients with angina pectoris refractory to anti-anginal medication and with coronary arteries not amenable to traditional revascularisation, does surgical sympathectomy improve clinical outcomes?

Methods

The Medline database was searched from 1946 to 2015 using the strategy: (sympathectomy OR sympathetic OR neurosurg*) AND angina. Abstracts were independently screened by two authors. Relevant articles were read in full and their reference lists searched for additional pertinent studies. The best available evidence was analysed and tabulated.

Results

Six papers were identified that represented the best evidence; 5 case series, and 1 prospective cohort study. All 5 case series demonstrated an improvement in symptoms, exercise tolerance and/or quality of life in patients undergoing surgical sympathectomy. The cohort study compared sympathectomy with transmyocardial laser revascularisation (TMR), and concluded TMR to be superior. However this study looked only at unilateral sympathectomy, whereas all 5 case series focused on bilateral surgery.

Conclusion

The best available evidence for sympathectomy as a treatment for angina pectoris shows that patients tend to report a reduction in pain and improved quality of life following surgery, but the low level of evidence does not allow for a statistically proven statement of efficacy. Until more robust data are available, the benefit of this surgery on clinical outcomes should be considered unproven.