For patients with refractory angina pectoris, coronary artery bypass grafting (CABG) plus transmyocardial revascularization (TMR) by laser offers durable improvements, study results indicate.
Dr. Steven W. Boyce and others from Washington Hospital Center in the District of Columbia investigated early and late outcomes of 169 consecutive patients, mean age 63, who were followed for one year after undergoing CABG plus TMR for intractable angina pectoris.
All patients had at least one myocardial ischemic area not amenable to surgical revascularization, 82% were considered inoperable by other hospitals due to small vessels or diffuse disease, and 52% were diabetic.
The team reports, in The American Journal of Cardiology for June 15th, that one-year actuarial and event-free survival rates were 85% and 81%, respectively. While 152 patients (90%) were in angina class III/IV at baseline, only 7 patients (4%) remained so one year after CABG plus TMR (p<0.001). Advanced age, prolonged ICU stay, new-onset atrial fibrillation, and in-hospital MI were predictive of major adverse cardiac events, with odds ratios of 3.4, 3.3, 2.8, and 1.5, respectively. Dr. Boyce’s team concludes, based on this study, that the CABG/TMR approach is “a safe revascularization option for patients with serious comorbid conditions and areas of myocardial tissue not amenable to surgical revascularization.” They urge prospective, randomized trials, however, emphasizing that a “single-institution success with a novel approach does not make it an acceptable treatment modality.” Am J Cardiol 2002;89:1365-1368.