title: Factors influencing results and outcome after transmyocardial laser revascularization.
abstract: BACKGROUND
  Transmyocardial laser revascularization (TMR) has been increasingly used during the recent past for patients with diffuse coronary artery disease. Because this operation is associated with significant morbidity and mortality, it is important to select patients for TMR who are likely to benefit from the procedure.
  
  
  METHODS
  We performed an univariate logistic regression analysis of 20 factors on the benefits and outcomes of 134 patients who underwent isolated TMR at our institution between November 1994 and May 2000.
  
  
  RESULTS
  Responders and nonresponders differed significantly with regard to the incidence of diabetes mellitus. For diabetic patients the chance of profiting from the TMR operation was only 43% of that of nondiabetic patients (odds ratio = 0.43 [0.20 to 0.92]). Furthermore, patients with a preoperative body mass index of less than 25 had a threefold increase in the probability of death during the first year after TMR as compared to patients whose body mass index was 25 or more (odds ratio = 2.97 [1.05 to 8.40]). The incidence of diabetes was also slightly but not significantly different between 1-year survivors and nonsurvivors.
  
  
  CONCLUSIONS
  In diabetic patients we recommend caution in selecting therapeutic TMR because outcomes are less satisfactory than in nondiabetics. Furthermore, patients with a body mass index below 25 have a significantly higher risk for death during the first postoperative year. Studies based on larger patient populations should follow.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany. krabatsch@dhzb.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Krabatsch
authors.forename: Rainer
authors.initials: R
authors.lastname: Petzina
authors.forename: Harald
authors.initials: H
authors.lastname: Hausmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Koster
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000601:surgery*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D053685:Laser Therapy; D016015:Logistic Models; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome