TY - JOUR
T1 - Transmyocardial laser revascularisation compared with continued medical therapy for treatment of refractory angina pectoris
T2 - A prospective randomised trial
AU - Burkhoff, Daniel
AU - Schmidt, Sheila
AU - Schulman, Steven P.
AU - Myers, Jonathan
AU - Resar, Jon
AU - Becker, Lewis C.
AU - Weiss, James
AU - Jones, James W.
N1 - Funding Information:
This study was supported by CardioGenesis Corporation, Sunnyvale C A, USA under the direction of Edward Brennan and Carole Marcot. The database was managed by Carol Giffen and Laurie Rich, Information Management Services, Silver Spring, MD. Statistical analyses were done by Margaret N Wesley, Information Management Services.
PY - 1999/9/11
Y1 - 1999/9/11
N2 - Background. Transmyocardial revascularisation (TMR) is an operative treatment for refractory angina pectoris when bypass surgery or percutaneous transluminal angioplasty is not indicated. We did a prospective randomised trial to compare TMR with continued medication. Methods. We recruited 182 patients from 16 US centres with Canadian Cardiovascular Society Angina (CCSA) score III (38%) or IV (62%), reversible ischaemia, and incomplete response to other therapies. Patients were randomly assigned TMR and continued medication (n = 92) or continued medication alone (n = 90). Baseline assessments were angina class, exercise tolerance, Seattle angina questionnaire for quality of life, and dipyridamole thallium stress rest. We reassessed patients at 3 months, 6 months, and 12 months, with independent masked angina assessment at 12 months. Findings. At 12 months, total exercise tolerance increased by a median of 65 s in the TMR group compared with a 46 s decrease in the medication-only group (p < 0.0001, median difference 111 s). Independent CCSA score was II or lower in 47.8% in the TMR group compared with 14.3% in the medication-only group (p < 0.001). Each Seattle angina questionnaire index increased in the TMR group significantly more than in the medication-only group (p < 0.001). Interpretation. TMR lowered angina scores, increased exercise tolerance time, and improved patients' perceptions of quality of life. This operative treatment provided clinical benefits in patients with no other therapeutic options.
AB - Background. Transmyocardial revascularisation (TMR) is an operative treatment for refractory angina pectoris when bypass surgery or percutaneous transluminal angioplasty is not indicated. We did a prospective randomised trial to compare TMR with continued medication. Methods. We recruited 182 patients from 16 US centres with Canadian Cardiovascular Society Angina (CCSA) score III (38%) or IV (62%), reversible ischaemia, and incomplete response to other therapies. Patients were randomly assigned TMR and continued medication (n = 92) or continued medication alone (n = 90). Baseline assessments were angina class, exercise tolerance, Seattle angina questionnaire for quality of life, and dipyridamole thallium stress rest. We reassessed patients at 3 months, 6 months, and 12 months, with independent masked angina assessment at 12 months. Findings. At 12 months, total exercise tolerance increased by a median of 65 s in the TMR group compared with a 46 s decrease in the medication-only group (p < 0.0001, median difference 111 s). Independent CCSA score was II or lower in 47.8% in the TMR group compared with 14.3% in the medication-only group (p < 0.001). Each Seattle angina questionnaire index increased in the TMR group significantly more than in the medication-only group (p < 0.001). Interpretation. TMR lowered angina scores, increased exercise tolerance time, and improved patients' perceptions of quality of life. This operative treatment provided clinical benefits in patients with no other therapeutic options.
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U2 - 10.1016/S0140-6736(99)08113-1
DO - 10.1016/S0140-6736(99)08113-1
M3 - Article
C2 - 10489946
AN - SCOPUS:0033546967
SN - 0140-6736
VL - 354
SP - 885
EP - 890
JO - Lancet
JF - Lancet
IS - 9182
ER -