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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.

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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