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Graft Plus Revascularization Safe For Intractable Angina
A DGReview of :"One-year outcome after combined coronary artery bypass grafting and transmyocardial laser revascularization for refractory angina pectoris"
American Journal of Cardiology
07/09/2002
By Harvey McConnell
Coronary artery bypass graft surgery (CABG) plus transmyocardial revascularization (TMR) appears to be a safe procedure for patients with intractable angina pectoris.
Clinicians at the Section of Cardiac Surgery, Washington Hospital Center, Washington, DC, say little has been known about long-term outcome after CABG plus TMR.
In their study, 169 patients underwent CABG plus TMR at a mean age of 63. They had refractory angina pectoris and a myocardial ischemic area not amenable to CABG, and 70 percent were men.
Among this cohort, 51 percent had previously had CABG, and 82 percent were deemed inoperable at other heart surgery centers due to small vessels or diffuse disease.
The patients, treated between March 1996 and February 2000, were clinically followed-up at 30 days, and three, six, and 12 months after CABG. Primary endpoints included survival, stroke, acute myocardial infarction, and revascularization, as well as subsequent class of angina.
Clinicians found at one year that actuarial survival was 85 percent among the cohort, and event-free survival was 81 percent. During this first year following surgery, seven patients (four percent) had angina class III/IV compared with 152 patients (90 percent) at baseline.
Predictors of major adverse cardiac events were advanced age, prolonged intensive care unit stay, new-onset atrial fibrillation, and in-hospital myocardial infarction.
Clinicians conclude that procedural success at 30 days, and overall event-free and actuarial survival in a high-risk population setting, "shows that CABG plus TMR is a safe revascularization option for patients with intractable angina pectoris."
Amer J Cardiology Vol 89, issue 12, pp 1365-1368.
"One-year outcome after combined coronary artery bypass grafting and transmyocardial laser revascularization for refractory angina pectoris"
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