Document Detail


Impact of unstable angina on outcomes of transmyocardial laser revascularization combined with coronary artery bypass grafting.
MedLine Citation:
PMID:  16305849     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: For sole therapy transmyocardial laser revascularization (TMR), unstable angina has been demonstrated to be a significant independent predictor of operative mortality. The objective of this study was to investigate the preoperative risk profile of patients undergoing TMR plus coronary artery bypass graft surgery (CABG) and to determine the impact of unstable angina on outcomes. METHODS: Using The Society of Thoracic Surgeons National Cardiac Database from 1998 to 2003, 5,618 patients underwent TMR plus CABG. These patients were compared with 932,715 patients who underwent CABG only operations. RESULTS: The TMR plus CABG patients had a significantly higher incidence of diabetes (50% versus 34%), renal failure (7% versus 5%), peripheral vascular disease (20% versus 16%), reoperative surgery (26% versus 9%), three-vessel coronary artery disease (80% versus 71%), hyperlipidemia (73% versus 62%; p < 0.001 for all comparisons). The incidence of preoperative unstable angina was similar (46% versus 47%). The unadjusted perioperative mortality was 3.8% for TMR plus CABG patients. When unstable angina patients were removed, the observed mortality for TMR plus CABG was decreased to 2.7%. CONCLUSIONS: It is likely that patients who undergo TMR plus CABG have a higher prevalence of diffuse coronary disease based on their preoperative demographics. Despite the increased risk associated with such anatomy, the mortality rate was not significantly increased when TMR was added to CABG in an effort to provide a more complete revascularization. As was noted from the outcomes of sole therapy TMR, in unstable angina patients, TMR plus CABG carries a higher risk, but this risk is not significantly different from that of such patients treated with CABG alone.
Authors:
Keith A Horvath; T Bruce Ferguson; Robert A Guyton; Fred H Edwards
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  80     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-11-24     Completed Date:  2005-12-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  2082-5     Citation Subset:  AIM; IM    
Affiliation:
National Heart, Lung, Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA. khorvath@nih.gov
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MeSH Terms
Descriptor/Qualifier:
Angina, Unstable / complications*
Coronary Artery Bypass
Coronary Artery Disease / complications*,  surgery*
Humans
Laser Therapy*
Myocardial Revascularization / methods*
Risk Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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