CLINICAL STUDY: RANSMYOCARDIAL REVASCULARIZATION
Continued symptomatic improvement three to five years after transmyocardial revascularization with co2 laser
A late clinical follow-up of the norwegian randomized trial with transmyocardial revascularization
Lars Aaberge, MD*,*,
Kjell Rootwelt, MD, PhD ,
Svein Blomhoff, MD, PhD ,
Kjell Saatvedt, MD, PhD ,
Michel Abdelnoor, MPH, PhD|| and
Kolbjorn Forfang, MD, PhD*
* Department of Cardiology, Rikshospitalet University Hospital, Oslo, Norway
Department of Clinical Chemistry/Section of Nuclear Medicine, Rikshospitalet University Hospital, Oslo, Norway
Department of Psychiatry, Rikshospitalet University Hospital, Oslo, Norway
Feiringklinikken, Feiring, Oslo, Norway
|| Ullevaal University Hospital, Oslo, Norway
Manuscript received October 15, 2001;
revised manuscript received February 21, 2002,
accepted February 22, 2002.
* Reprint requests and correspondence: Dr. Lars Aaberge, Feiringklinikken, N-2093 Feiring, Norway. laaaberg{at}online.no
OBJECTIVES: The goals of this study were to assess late clinical outcome and left ventricular ejection fraction (LVEF) after transmyocardial revascularization with CO2 laser (TMR).
BACKGROUND: During the 1990s TMR emerged as a treatment option for patients with refractory angina not eligible for conventional revascularization. Few reports exist on clinical effects and LVEF >3 years after TMR.
METHODS: One hundred patients with refractory angina not eligible for conventional revascularization were block-randomized 1:1 to receive continued medical treatment or medical treatment combined with TMR. The patients were evaluated at baseline and after 3, 12 and 43 (range: 32 to 60) months with end points to angina, hospitalizations due to acute myocardial infarctions or unstable angina, heart failure and LVEF. Mortality was registered and MOS 36 Short-Form Health Survey answered at baseline and after 3, 6 and 12 months.
RESULTS: Forty-three months after TMR, angina symptoms were still significantly improved, and unstable angina hospitalizations reduced by 55% (p < 0.001). Heart failure treatment (p < 0.01) increased, whereas the number of acute myocardial infarctions, LVEF and mortality was not affected. Quality of life was improved 3, 6 and 12 months after TMR.
CONCLUSIONS: Forty-three months after TMR, angina symptoms and hospitalizations due to unstable angina were significantly reduced, heart failure treatment increased and LVEF and mortality were seemingly unaffected.
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Abbreviations and Acronyms
| | DSE | | dobutamine stress echocardiography | | LVEF | | left ventricular ejection fraction | | MCS | | summary mental component scale | | MT | | medical treatment | | MUGA | | multiple-gated acquisition | | NYHA | | New York Heart Association | | OBL | | baseline outcome variable | | OFU | | follow-up outcome variable | | PCS | | summary physical component scale | | QoL | | quality of life | | SF-36 | | MOS 36 Short-Form Health Survey | | SPECT | | technetium 99m-tetrofosmin myocardial perfusion scan | | TMR | | transmyocardial revascularization with CO2 laser |
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