Intermediate-term clinical outcome following transmyocardial laser revascularization in patients with refractory angina pectoris

Carolyn K. Landolfo, Kevin P. Landolfo, G. Chad Hughes, Edward R. Coleman, Robin B. Coleman, James E. Lowe

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background - This study was conducted to examine the intermediate-term clinical outcomes in patients with refractory angina pectoris treated with transmyocardial laser revascularization (TMR) at our institution. TMR is an alternative surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Limited data exist evaluating the natural history and duration of clinical improvement in angina pectoris following TMR. Methods and Results -Thirty-four patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques underwent TMR in myocardial regions determined to be ischemic by preoperative SPECT 201Tl perfusion imaging following dipyridamole stress. Patients were assessed postoperatively at 3, 6, and 12 months for clinical outcomes including death, myocardial infarction, functional class of angina pectoris, and hospitalizations for unstable angina. Myocardial perfusion imaging by 201Tl scintigraphy was also assessed at these temporal end points. Overall mortality at I year was 14.7% (n=5). Nonfatal myocardial infarction occurred in 3 patients (8.8%). Among the patients with complete 12-month follow-up (n =27), mean anginal class improved from 3.5±0.5 pre-TMR to 2.8 ± 0.7 and 2.5±0.7 at 3 and 6 months, respectively, and 2.8±0.9 at 12 months. Overall improvement in angina pectoris was sustained at 1 year by at least one functional class in 50% of patients. Mean hospitalizations per year for unstable angina declined from 2.4±1.6 pre-TMR to 1.7±-2.0 post-TMR (P=0.01). There was no significant improvement in perfusion by SPECT 201Tl imaging at any temporal end point post-TMR. Conclusions - Despite the lack of demonstrable improvement in perfusion by SPECT 201Tl imaging, TMR improved the functional class of angina pectoris in patients with end stage coronary artery disease to a modest degree. Although the maximal benefit in symptoms occurred at 6 months post-TMR, mild sustained clinical improvement above baseline was evident in 50% of patients at 1 year.

Original languageEnglish (US)
JournalCirculation
Volume100
Issue number19 SUPPL.
StatePublished - Nov 9 1999
Externally publishedYes

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Transmyocardial Laser Revascularization
Angina Pectoris
Unstable Angina
Single-Photon Emission-Computed Tomography
Coronary Artery Disease
Hospitalization
Perfusion
Myocardial Infarction
Myocardial Perfusion Imaging
Perfusion Imaging
Dipyridamole
Natural History
Radionuclide Imaging
Myocardial Ischemia

Keywords

  • Angiogenesis
  • Coronary disease
  • Lasers
  • Perfusion
  • Revascularization

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Landolfo, C. K., Landolfo, K. P., Hughes, G. C., Coleman, E. R., Coleman, R. B., & Lowe, J. E. (1999). Intermediate-term clinical outcome following transmyocardial laser revascularization in patients with refractory angina pectoris. Circulation, 100(19 SUPPL.).

Intermediate-term clinical outcome following transmyocardial laser revascularization in patients with refractory angina pectoris. / Landolfo, Carolyn K.; Landolfo, Kevin P.; Hughes, G. Chad; Coleman, Edward R.; Coleman, Robin B.; Lowe, James E.

In: Circulation, Vol. 100, No. 19 SUPPL., 09.11.1999.

Research output: Contribution to journalArticle

Landolfo, CK, Landolfo, KP, Hughes, GC, Coleman, ER, Coleman, RB & Lowe, JE 1999, 'Intermediate-term clinical outcome following transmyocardial laser revascularization in patients with refractory angina pectoris', Circulation, vol. 100, no. 19 SUPPL..
Landolfo CK, Landolfo KP, Hughes GC, Coleman ER, Coleman RB, Lowe JE. Intermediate-term clinical outcome following transmyocardial laser revascularization in patients with refractory angina pectoris. Circulation. 1999 Nov 9;100(19 SUPPL.).
Landolfo, Carolyn K. ; Landolfo, Kevin P. ; Hughes, G. Chad ; Coleman, Edward R. ; Coleman, Robin B. ; Lowe, James E. / Intermediate-term clinical outcome following transmyocardial laser revascularization in patients with refractory angina pectoris. In: Circulation. 1999 ; Vol. 100, No. 19 SUPPL.
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abstract = "Background - This study was conducted to examine the intermediate-term clinical outcomes in patients with refractory angina pectoris treated with transmyocardial laser revascularization (TMR) at our institution. TMR is an alternative surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Limited data exist evaluating the natural history and duration of clinical improvement in angina pectoris following TMR. Methods and Results -Thirty-four patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques underwent TMR in myocardial regions determined to be ischemic by preoperative SPECT 201Tl perfusion imaging following dipyridamole stress. Patients were assessed postoperatively at 3, 6, and 12 months for clinical outcomes including death, myocardial infarction, functional class of angina pectoris, and hospitalizations for unstable angina. Myocardial perfusion imaging by 201Tl scintigraphy was also assessed at these temporal end points. Overall mortality at I year was 14.7{\%} (n=5). Nonfatal myocardial infarction occurred in 3 patients (8.8{\%}). Among the patients with complete 12-month follow-up (n =27), mean anginal class improved from 3.5±0.5 pre-TMR to 2.8 ± 0.7 and 2.5±0.7 at 3 and 6 months, respectively, and 2.8±0.9 at 12 months. Overall improvement in angina pectoris was sustained at 1 year by at least one functional class in 50{\%} of patients. Mean hospitalizations per year for unstable angina declined from 2.4±1.6 pre-TMR to 1.7±-2.0 post-TMR (P=0.01). There was no significant improvement in perfusion by SPECT 201Tl imaging at any temporal end point post-TMR. Conclusions - Despite the lack of demonstrable improvement in perfusion by SPECT 201Tl imaging, TMR improved the functional class of angina pectoris in patients with end stage coronary artery disease to a modest degree. Although the maximal benefit in symptoms occurred at 6 months post-TMR, mild sustained clinical improvement above baseline was evident in 50{\%} of patients at 1 year.",
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AU - Landolfo, Carolyn K.

AU - Landolfo, Kevin P.

AU - Hughes, G. Chad

AU - Coleman, Edward R.

AU - Coleman, Robin B.

AU - Lowe, James E.

PY - 1999/11/9

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N2 - Background - This study was conducted to examine the intermediate-term clinical outcomes in patients with refractory angina pectoris treated with transmyocardial laser revascularization (TMR) at our institution. TMR is an alternative surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Limited data exist evaluating the natural history and duration of clinical improvement in angina pectoris following TMR. Methods and Results -Thirty-four patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques underwent TMR in myocardial regions determined to be ischemic by preoperative SPECT 201Tl perfusion imaging following dipyridamole stress. Patients were assessed postoperatively at 3, 6, and 12 months for clinical outcomes including death, myocardial infarction, functional class of angina pectoris, and hospitalizations for unstable angina. Myocardial perfusion imaging by 201Tl scintigraphy was also assessed at these temporal end points. Overall mortality at I year was 14.7% (n=5). Nonfatal myocardial infarction occurred in 3 patients (8.8%). Among the patients with complete 12-month follow-up (n =27), mean anginal class improved from 3.5±0.5 pre-TMR to 2.8 ± 0.7 and 2.5±0.7 at 3 and 6 months, respectively, and 2.8±0.9 at 12 months. Overall improvement in angina pectoris was sustained at 1 year by at least one functional class in 50% of patients. Mean hospitalizations per year for unstable angina declined from 2.4±1.6 pre-TMR to 1.7±-2.0 post-TMR (P=0.01). There was no significant improvement in perfusion by SPECT 201Tl imaging at any temporal end point post-TMR. Conclusions - Despite the lack of demonstrable improvement in perfusion by SPECT 201Tl imaging, TMR improved the functional class of angina pectoris in patients with end stage coronary artery disease to a modest degree. Although the maximal benefit in symptoms occurred at 6 months post-TMR, mild sustained clinical improvement above baseline was evident in 50% of patients at 1 year.

AB - Background - This study was conducted to examine the intermediate-term clinical outcomes in patients with refractory angina pectoris treated with transmyocardial laser revascularization (TMR) at our institution. TMR is an alternative surgical technique for the treatment of myocardial ischemia and angina pectoris not amenable to conventional percutaneous or surgical revascularization. Limited data exist evaluating the natural history and duration of clinical improvement in angina pectoris following TMR. Methods and Results -Thirty-four patients with severe coronary artery disease unsuitable for treatment with standard revascularization techniques underwent TMR in myocardial regions determined to be ischemic by preoperative SPECT 201Tl perfusion imaging following dipyridamole stress. Patients were assessed postoperatively at 3, 6, and 12 months for clinical outcomes including death, myocardial infarction, functional class of angina pectoris, and hospitalizations for unstable angina. Myocardial perfusion imaging by 201Tl scintigraphy was also assessed at these temporal end points. Overall mortality at I year was 14.7% (n=5). Nonfatal myocardial infarction occurred in 3 patients (8.8%). Among the patients with complete 12-month follow-up (n =27), mean anginal class improved from 3.5±0.5 pre-TMR to 2.8 ± 0.7 and 2.5±0.7 at 3 and 6 months, respectively, and 2.8±0.9 at 12 months. Overall improvement in angina pectoris was sustained at 1 year by at least one functional class in 50% of patients. Mean hospitalizations per year for unstable angina declined from 2.4±1.6 pre-TMR to 1.7±-2.0 post-TMR (P=0.01). There was no significant improvement in perfusion by SPECT 201Tl imaging at any temporal end point post-TMR. Conclusions - Despite the lack of demonstrable improvement in perfusion by SPECT 201Tl imaging, TMR improved the functional class of angina pectoris in patients with end stage coronary artery disease to a modest degree. Although the maximal benefit in symptoms occurred at 6 months post-TMR, mild sustained clinical improvement above baseline was evident in 50% of patients at 1 year.

KW - Angiogenesis

KW - Coronary disease

KW - Lasers

KW - Perfusion

KW - Revascularization

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