Transmyocardial revascularization: 5-year follow-up of a prospective, randomized multicenter trial

Keith B. Allen, Robert D. Dowling, William W. Angell, Deepak M. Gangahar, Tommy L. Fudge, Wayne Richenbacher, Samuel L. Selinger, Michael R. Petracek, Douglas Murphy

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Background In prospective randomized trials at 1 year, transmyocardial revascularization (TMR) provided superior relief of angina, decreased rehospitalizations, and improved exercise times. We evaluated 5-year mortality and angina class in "no-option" patients with diffuse coronary artery disease randomized to TMR or continued medical management. Methods Two hundred twelve patients with refractory class IV angina who were not candidates for conventional therapy were randomized to receive holmium:yttrium-aluminum-garnet TMR (n = 100) or continued medical management (n = 112) at nine centers. Follow-up included all-cause mortality along with angina class assessment by blinded evaluators. Mean follow-up was 5.7 ± 0.8 years. Results Mean angina scores for TMR patients were 4.0 ± 0.0 at baseline, 1.5 ± 1.4 at 1 year, and 1.2 ± 1.1 at a mean of 5 years (p < 0.001). After an average of 5 years, a significantly greater proportion of TMR than medical management patients experienced two or more class improvement in angina (88% versus 44%; p < 0.001). Kaplan-Meier intention-to-treat survival at 5 years was 65% versus 52% (TMR versus medical management; p = 0.05). Cumulative hazard curves demonstrated a significantly reduced risk of late death for TMR patients; average annual mortality beyond 1 year was 8% versus 13% (TMR versus medical management; p = 0.03). Conclusions Five-year follow-up of prospectively randomized, no-option class IV angina patients demonstrated significantly increased Kaplan-Meier survival in patients randomized to TMR. The significant angina relief observed 12 months after sole therapy TMR was sustained long term and continued to be superior to that observed for patients maintained on continued medical management alone.

Original languageEnglish (US)
Pages (from-to)1228-1234
Number of pages7
JournalAnnals of Thoracic Surgery
Volume77
Issue number4
DOIs
StatePublished - Apr 1 2004

Fingerprint

Multicenter Studies
Mortality
Holmium
Survival
Coronary Artery Disease
Exercise
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Allen, Keith B. ; Dowling, Robert D. ; Angell, William W. ; Gangahar, Deepak M. ; Fudge, Tommy L. ; Richenbacher, Wayne ; Selinger, Samuel L. ; Petracek, Michael R. ; Murphy, Douglas. / Transmyocardial revascularization : 5-year follow-up of a prospective, randomized multicenter trial. In: Annals of Thoracic Surgery. 2004 ; Vol. 77, No. 4. pp. 1228-1234.
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title = "Transmyocardial revascularization: 5-year follow-up of a prospective, randomized multicenter trial",
abstract = "Background In prospective randomized trials at 1 year, transmyocardial revascularization (TMR) provided superior relief of angina, decreased rehospitalizations, and improved exercise times. We evaluated 5-year mortality and angina class in {"}no-option{"} patients with diffuse coronary artery disease randomized to TMR or continued medical management. Methods Two hundred twelve patients with refractory class IV angina who were not candidates for conventional therapy were randomized to receive holmium:yttrium-aluminum-garnet TMR (n = 100) or continued medical management (n = 112) at nine centers. Follow-up included all-cause mortality along with angina class assessment by blinded evaluators. Mean follow-up was 5.7 ± 0.8 years. Results Mean angina scores for TMR patients were 4.0 ± 0.0 at baseline, 1.5 ± 1.4 at 1 year, and 1.2 ± 1.1 at a mean of 5 years (p < 0.001). After an average of 5 years, a significantly greater proportion of TMR than medical management patients experienced two or more class improvement in angina (88{\%} versus 44{\%}; p < 0.001). Kaplan-Meier intention-to-treat survival at 5 years was 65{\%} versus 52{\%} (TMR versus medical management; p = 0.05). Cumulative hazard curves demonstrated a significantly reduced risk of late death for TMR patients; average annual mortality beyond 1 year was 8{\%} versus 13{\%} (TMR versus medical management; p = 0.03). Conclusions Five-year follow-up of prospectively randomized, no-option class IV angina patients demonstrated significantly increased Kaplan-Meier survival in patients randomized to TMR. The significant angina relief observed 12 months after sole therapy TMR was sustained long term and continued to be superior to that observed for patients maintained on continued medical management alone.",
author = "Allen, {Keith B.} and Dowling, {Robert D.} and Angell, {William W.} and Gangahar, {Deepak M.} and Fudge, {Tommy L.} and Wayne Richenbacher and Selinger, {Samuel L.} and Petracek, {Michael R.} and Douglas Murphy",
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Allen, KB, Dowling, RD, Angell, WW, Gangahar, DM, Fudge, TL, Richenbacher, W, Selinger, SL, Petracek, MR & Murphy, D 2004, 'Transmyocardial revascularization: 5-year follow-up of a prospective, randomized multicenter trial', Annals of Thoracic Surgery, vol. 77, no. 4, pp. 1228-1234. https://doi.org/10.1016/j.athoracsur.2004.01.008

Transmyocardial revascularization : 5-year follow-up of a prospective, randomized multicenter trial. / Allen, Keith B.; Dowling, Robert D.; Angell, William W.; Gangahar, Deepak M.; Fudge, Tommy L.; Richenbacher, Wayne; Selinger, Samuel L.; Petracek, Michael R.; Murphy, Douglas.

In: Annals of Thoracic Surgery, Vol. 77, No. 4, 01.04.2004, p. 1228-1234.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Transmyocardial revascularization

T2 - 5-year follow-up of a prospective, randomized multicenter trial

AU - Allen, Keith B.

AU - Dowling, Robert D.

AU - Angell, William W.

AU - Gangahar, Deepak M.

AU - Fudge, Tommy L.

AU - Richenbacher, Wayne

AU - Selinger, Samuel L.

AU - Petracek, Michael R.

AU - Murphy, Douglas

PY - 2004/4/1

Y1 - 2004/4/1

N2 - Background In prospective randomized trials at 1 year, transmyocardial revascularization (TMR) provided superior relief of angina, decreased rehospitalizations, and improved exercise times. We evaluated 5-year mortality and angina class in "no-option" patients with diffuse coronary artery disease randomized to TMR or continued medical management. Methods Two hundred twelve patients with refractory class IV angina who were not candidates for conventional therapy were randomized to receive holmium:yttrium-aluminum-garnet TMR (n = 100) or continued medical management (n = 112) at nine centers. Follow-up included all-cause mortality along with angina class assessment by blinded evaluators. Mean follow-up was 5.7 ± 0.8 years. Results Mean angina scores for TMR patients were 4.0 ± 0.0 at baseline, 1.5 ± 1.4 at 1 year, and 1.2 ± 1.1 at a mean of 5 years (p < 0.001). After an average of 5 years, a significantly greater proportion of TMR than medical management patients experienced two or more class improvement in angina (88% versus 44%; p < 0.001). Kaplan-Meier intention-to-treat survival at 5 years was 65% versus 52% (TMR versus medical management; p = 0.05). Cumulative hazard curves demonstrated a significantly reduced risk of late death for TMR patients; average annual mortality beyond 1 year was 8% versus 13% (TMR versus medical management; p = 0.03). Conclusions Five-year follow-up of prospectively randomized, no-option class IV angina patients demonstrated significantly increased Kaplan-Meier survival in patients randomized to TMR. The significant angina relief observed 12 months after sole therapy TMR was sustained long term and continued to be superior to that observed for patients maintained on continued medical management alone.

AB - Background In prospective randomized trials at 1 year, transmyocardial revascularization (TMR) provided superior relief of angina, decreased rehospitalizations, and improved exercise times. We evaluated 5-year mortality and angina class in "no-option" patients with diffuse coronary artery disease randomized to TMR or continued medical management. Methods Two hundred twelve patients with refractory class IV angina who were not candidates for conventional therapy were randomized to receive holmium:yttrium-aluminum-garnet TMR (n = 100) or continued medical management (n = 112) at nine centers. Follow-up included all-cause mortality along with angina class assessment by blinded evaluators. Mean follow-up was 5.7 ± 0.8 years. Results Mean angina scores for TMR patients were 4.0 ± 0.0 at baseline, 1.5 ± 1.4 at 1 year, and 1.2 ± 1.1 at a mean of 5 years (p < 0.001). After an average of 5 years, a significantly greater proportion of TMR than medical management patients experienced two or more class improvement in angina (88% versus 44%; p < 0.001). Kaplan-Meier intention-to-treat survival at 5 years was 65% versus 52% (TMR versus medical management; p = 0.05). Cumulative hazard curves demonstrated a significantly reduced risk of late death for TMR patients; average annual mortality beyond 1 year was 8% versus 13% (TMR versus medical management; p = 0.03). Conclusions Five-year follow-up of prospectively randomized, no-option class IV angina patients demonstrated significantly increased Kaplan-Meier survival in patients randomized to TMR. The significant angina relief observed 12 months after sole therapy TMR was sustained long term and continued to be superior to that observed for patients maintained on continued medical management alone.

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U2 - 10.1016/j.athoracsur.2004.01.008

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