Adjunctive transmyocardial revascularization: five-year follow-up of a prospective, randomized trial.
BACKGROUND
In a prospective, randomized trial involving 263 patients who would be incompletely revascularized by coronary artery bypass grafting (CABG) alone, CABG plus transmyocardial revascularization (CABG/TMR) provided an early mortality benefit with similar angina relief compared with CABG alone at 1 year. We evaluated the long-term outcome of patients randomized to CABG/TMR or CABG alone.


METHODS
Thirteen centers that enrolled 83% (218/263) of the patients in the original trial participated in this longitudinal study. Between 1996 and 1998, these centers randomized 218 patients who would be incompletely revascularized by CABG alone because of diffusely diseased target vessels to either holmium:yttrium-aluminum-garnet (holmium:YAG) CABG/TMR (n = 110) or CABG alone (n = 108). Baseline demographics and operative characteristics were similar between groups. Follow-up (mean 5.0 +/- 1.7 years) included survival and blinded angina class assessment.


RESULTS
At this 5-year follow-up both groups experienced significant angina improvement from baseline, however, the CABG/TMR group had a lower mean angina score (0.4 +/- 0.7 vs 0.7 +/- 1.1, p = 0.05), a significantly lower proportion of patients with severe angina (class III/IV: 0% [0/68] vs 10% [6/60], p = 0.009), and a trend towards greater number of angina-free patients (78% [53/68] vs 63% [38/60], p = 0.08), compared with CABG alone patients. Kaplan-Meier survival at 6 years was similar between CABG/TMR and CABG alone patients (76% vs 80%, p = 0.90).


CONCLUSIONS
Five-year follow-up of prospectively randomized patients who would be incompletely revascularized because of diffuse coronary artery disease indicates that the addition of TMR to conventional CABG provides superior angina relief compared to CABG alone.
Department of Cardiothoracic Surgery, St. Vincent Hospital, Indiana Heart Institute, 10590 N. Meridian Street, Suite 105, Indianapolis, IN 46260, USA. kallen2340@aol.com
Keith B
KB
Allen
Robert D
RD
Dowling
Douglas R
DR
Schuch
Thomas A
TA
Pfeffer
Steven
S
Marra
Edward A
EA
Lefrak
Tommy L
TL
Fudge
Mark
M
Mostovych
Szabolc
S
Szentpetery
Sibu P
SP
Saha
Douglas
D
Murphy
Hugh
H
Dennis
D000368:Aged; D000787:Angina Pectoris / Q000601:surgery*; D001026:Coronary Artery Bypass; D048909:Diabetes Complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000706:statistics & numerical data*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D016037:Single-Blind Method; D016019:Survival Analysis; D016896:Treatment Outcome