TMR Tied to Increased 5-Year Survival in “No-Option” Angina Patients

Previous reports have shown that transmyocardial revascularization (TMR) can provide many short-term benefits for class IV

angina patients who are not candidates for traditional methods of revascularization. Now, new research shows that TMR also provides long-term symptom relief and improved survival.

The findings, which are reported in the Annals of Thoracic Surgery for April, are based on a study of 212 “no-option” angina patients who were randomized to undergo laser TMR or to continue their medical management. The mean follow-up period was 5.7 years.

TMR was associated with a significant reduction in mean angina scores that persisted over 5 years (p < 0.001), lead author Dr. Keith B. Allen, from the Indiana Heart Institute in Indianapolis, and colleagues note. Moreover, during the study period, 88% of TMR-treated patients improved their angina status by two or more classes compared with just 44% of patients in the control group (p < 0.001). TMR was also linked to improved survival, the investigators state. The 5-year intention-to-treat survival rates for the TMR and control groups were 65% and 52%, respectively (p = 0.05). Also, after the first year, average annual mortality in the TMR group was 8%, significantly lower than the 13% rate seen in the control group. “This is the first long-term follow-up of prospectively randomized patients reported with holmium:YAG TMR,” the investigators point out. “These data further support the aggressive use of TMR in no-option patients with medically refractory angina.” Ann Thorac Surg 2004;77:1228-1234.