Factors correlating with risk of mortality after transmyocardial revascularization
OBJECTIVES The purpose of this study was to determine factors correlating with the risk of postoperative mortality after transmyocardial laser revascularization (TMR). BACKGROUND Clinical studies have indicated that TMR reduces angina by an average of two classes in patients with medically refractor...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1999-07, Vol.34 (1), p.55-61 |
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| creator | Burkhoff, Daniel Wesley, Margaret N Resar, Jon R Lansing, Allan M |
| description | OBJECTIVES
The purpose of this study was to determine factors correlating with the risk of postoperative mortality after transmyocardial laser revascularization (TMR).
BACKGROUND
Clinical studies have indicated that TMR reduces angina by an average of two classes in patients with medically refractory symptoms not treatable by coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty. Factors which correlate with mortality after TMR, however, have not been extensively investigated.
METHODS
One hundred thirty-two patients with severe angina underwent TMR as sole therapy with a CO2laser. Age, gender, ejection fraction, prior CABG, unstable angina and the severity of coronary artery disease (graded on the basis of a newly proposed Anatomic Myocardial Perfusion index, AMP) were each determined. Each vascular territory (left anterior descending artery [LAD] left circumflex artery and posterior descending artery [PDA]) was graded as either having (AMP = 1) or not having (AMP = 0) blood flow through an unobstructed major vessel in the territory. Univariate and multivariate analysis determined which factors correlated with mortality.
RESULTS
Patients with at least one AMP = 1 vascular territory (overall AMP = 1) had a 5% (4/82) postoperative mortality rate (POM), compared with 25% (12/49) with overall AMP 0 (p = 0.002). Left anterior descending artery AMP (p = 0.03) and previous CABG (p = 0.04) each correlated with the risk of POM. However, multivariate analysis indicated that no factor improved the correlation obtained with overall AMP by itself. With regard to overall mortality (Kaplan-Meier curves), univariate analysis also revealed correlations with overall AMP (p < 0.001), LAD AMP (p = 0.005), previous CABG (p = 0.003) and PDA AMP (p = 0.05) each individually correlated with mortality. Multivariate analysis indicated that overall AMP = 1, female gender and previous CABG together correlated best with lower postoperative mortality.
CONCLUSIONS
Patients with good blood flow to at least one region of the heart through a native artery or a patent vascular graft have a markedly reduced risk of perioperative and longer term mortality. |
| doi_str_mv | 10.1016/S0735-1097(99)00162-X |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_69876886</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S073510979900162X</els_id><sourcerecordid>69876886</sourcerecordid><originalsourceid>FETCH-LOGICAL-c499t-9df75fa2a3b842f96c0951710f0c67ed5cf96fe2e6413697ffc4e739ee2f66d03</originalsourceid><addsrcrecordid>eNqFkEtLxDAQx4Mouj4-gtKDiB6qSbtNmpPI4gsEwQd4CzGdaLRtdJJV1k9v9oF6cy4Dw-8_M_wI2Wb0kFHGj26pKKucUSn2pTygaVTkD0tkwKqqzstKimUy-EHWyHoIL5RSXjO5StYYLWWqYkBuzrSJHkNmPCK0Orr-Kft08TlDF14zb7POY9Sti5NM2wiYRdR96CbeaGycbjOEDx3MuNXovlLc95tkxeo2wNaib5D7s9O70UV-dX1-OTq5ys1QypjLxorK6kKXj_WwsJIbKismGLXUcAFNZdLMQgF8yEouhbVmCKKUAIXlvKHlBtmb731D_z6GEFXngoG21T34cVBc1oLXNU9gNQcN-hAQrHpD12mcKEbVVKaayVRTU0pKNZOpHlJuZ3Fg_NhB8yc1t5eA3QWQDOjWJjPGhV-urkUhyoQdzzFINj4coArGQW-gcQgmqsa7fz75BjMrkzQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>69876886</pqid></control><display><type>article</type><title>Factors correlating with risk of mortality after transmyocardial revascularization</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Burkhoff, Daniel ; Wesley, Margaret N ; Resar, Jon R ; Lansing, Allan M</creator><creatorcontrib>Burkhoff, Daniel ; Wesley, Margaret N ; Resar, Jon R ; Lansing, Allan M</creatorcontrib><description>OBJECTIVES
The purpose of this study was to determine factors correlating with the risk of postoperative mortality after transmyocardial laser revascularization (TMR).
BACKGROUND
Clinical studies have indicated that TMR reduces angina by an average of two classes in patients with medically refractory symptoms not treatable by coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty. Factors which correlate with mortality after TMR, however, have not been extensively investigated.
METHODS
One hundred thirty-two patients with severe angina underwent TMR as sole therapy with a CO2laser. Age, gender, ejection fraction, prior CABG, unstable angina and the severity of coronary artery disease (graded on the basis of a newly proposed Anatomic Myocardial Perfusion index, AMP) were each determined. Each vascular territory (left anterior descending artery [LAD] left circumflex artery and posterior descending artery [PDA]) was graded as either having (AMP = 1) or not having (AMP = 0) blood flow through an unobstructed major vessel in the territory. Univariate and multivariate analysis determined which factors correlated with mortality.
RESULTS
Patients with at least one AMP = 1 vascular territory (overall AMP = 1) had a 5% (4/82) postoperative mortality rate (POM), compared with 25% (12/49) with overall AMP 0 (p = 0.002). Left anterior descending artery AMP (p = 0.03) and previous CABG (p = 0.04) each correlated with the risk of POM. However, multivariate analysis indicated that no factor improved the correlation obtained with overall AMP by itself. With regard to overall mortality (Kaplan-Meier curves), univariate analysis also revealed correlations with overall AMP (p < 0.001), LAD AMP (p = 0.005), previous CABG (p = 0.003) and PDA AMP (p = 0.05) each individually correlated with mortality. Multivariate analysis indicated that overall AMP = 1, female gender and previous CABG together correlated best with lower postoperative mortality.
CONCLUSIONS
Patients with good blood flow to at least one region of the heart through a native artery or a patent vascular graft have a markedly reduced risk of perioperative and longer term mortality.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(99)00162-X</identifier><identifier>PMID: 10399992</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Angina Pectoris - mortality ; Angina Pectoris - surgery ; Biological and medical sciences ; Diseases of the cardiovascular system ; Female ; Humans ; Laser Therapy ; Male ; Medical sciences ; Middle Aged ; Myocardial Revascularization - methods ; Odds Ratio ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Retrospective Studies ; Risk Factors ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 1999-07, Vol.34 (1), p.55-61</ispartof><rights>1999 American College of Cardiology</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-9df75fa2a3b842f96c0951710f0c67ed5cf96fe2e6413697ffc4e739ee2f66d03</citedby><cites>FETCH-LOGICAL-c499t-9df75fa2a3b842f96c0951710f0c67ed5cf96fe2e6413697ffc4e739ee2f66d03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S073510979900162X$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>309,310,314,776,780,785,786,3537,23909,23910,25118,27901,27902,65534</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1887273$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10399992$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Burkhoff, Daniel</creatorcontrib><creatorcontrib>Wesley, Margaret N</creatorcontrib><creatorcontrib>Resar, Jon R</creatorcontrib><creatorcontrib>Lansing, Allan M</creatorcontrib><title>Factors correlating with risk of mortality after transmyocardial revascularization</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>OBJECTIVES
The purpose of this study was to determine factors correlating with the risk of postoperative mortality after transmyocardial laser revascularization (TMR).
BACKGROUND
Clinical studies have indicated that TMR reduces angina by an average of two classes in patients with medically refractory symptoms not treatable by coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty. Factors which correlate with mortality after TMR, however, have not been extensively investigated.
METHODS
One hundred thirty-two patients with severe angina underwent TMR as sole therapy with a CO2laser. Age, gender, ejection fraction, prior CABG, unstable angina and the severity of coronary artery disease (graded on the basis of a newly proposed Anatomic Myocardial Perfusion index, AMP) were each determined. Each vascular territory (left anterior descending artery [LAD] left circumflex artery and posterior descending artery [PDA]) was graded as either having (AMP = 1) or not having (AMP = 0) blood flow through an unobstructed major vessel in the territory. Univariate and multivariate analysis determined which factors correlated with mortality.
RESULTS
Patients with at least one AMP = 1 vascular territory (overall AMP = 1) had a 5% (4/82) postoperative mortality rate (POM), compared with 25% (12/49) with overall AMP 0 (p = 0.002). Left anterior descending artery AMP (p = 0.03) and previous CABG (p = 0.04) each correlated with the risk of POM. However, multivariate analysis indicated that no factor improved the correlation obtained with overall AMP by itself. With regard to overall mortality (Kaplan-Meier curves), univariate analysis also revealed correlations with overall AMP (p < 0.001), LAD AMP (p = 0.005), previous CABG (p = 0.003) and PDA AMP (p = 0.05) each individually correlated with mortality. Multivariate analysis indicated that overall AMP = 1, female gender and previous CABG together correlated best with lower postoperative mortality.
CONCLUSIONS
Patients with good blood flow to at least one region of the heart through a native artery or a patent vascular graft have a markedly reduced risk of perioperative and longer term mortality.</description><subject>Aged</subject><subject>Angina Pectoris - mortality</subject><subject>Angina Pectoris - surgery</subject><subject>Biological and medical sciences</subject><subject>Diseases of the cardiovascular system</subject><subject>Female</subject><subject>Humans</subject><subject>Laser Therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Revascularization - methods</subject><subject>Odds Ratio</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkEtLxDAQx4Mouj4-gtKDiB6qSbtNmpPI4gsEwQd4CzGdaLRtdJJV1k9v9oF6cy4Dw-8_M_wI2Wb0kFHGj26pKKucUSn2pTygaVTkD0tkwKqqzstKimUy-EHWyHoIL5RSXjO5StYYLWWqYkBuzrSJHkNmPCK0Orr-Kft08TlDF14zb7POY9Sti5NM2wiYRdR96CbeaGycbjOEDx3MuNXovlLc95tkxeo2wNaib5D7s9O70UV-dX1-OTq5ys1QypjLxorK6kKXj_WwsJIbKismGLXUcAFNZdLMQgF8yEouhbVmCKKUAIXlvKHlBtmb731D_z6GEFXngoG21T34cVBc1oLXNU9gNQcN-hAQrHpD12mcKEbVVKaayVRTU0pKNZOpHlJuZ3Fg_NhB8yc1t5eA3QWQDOjWJjPGhV-urkUhyoQdzzFINj4coArGQW-gcQgmqsa7fz75BjMrkzQ</recordid><startdate>19990701</startdate><enddate>19990701</enddate><creator>Burkhoff, Daniel</creator><creator>Wesley, Margaret N</creator><creator>Resar, Jon R</creator><creator>Lansing, Allan M</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990701</creationdate><title>Factors correlating with risk of mortality after transmyocardial revascularization</title><author>Burkhoff, Daniel ; Wesley, Margaret N ; Resar, Jon R ; Lansing, Allan M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-9df75fa2a3b842f96c0951710f0c67ed5cf96fe2e6413697ffc4e739ee2f66d03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Angina Pectoris - mortality</topic><topic>Angina Pectoris - surgery</topic><topic>Biological and medical sciences</topic><topic>Diseases of the cardiovascular system</topic><topic>Female</topic><topic>Humans</topic><topic>Laser Therapy</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Revascularization - methods</topic><topic>Odds Ratio</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Burkhoff, Daniel</creatorcontrib><creatorcontrib>Wesley, Margaret N</creatorcontrib><creatorcontrib>Resar, Jon R</creatorcontrib><creatorcontrib>Lansing, Allan M</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Burkhoff, Daniel</au><au>Wesley, Margaret N</au><au>Resar, Jon R</au><au>Lansing, Allan M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors correlating with risk of mortality after transmyocardial revascularization</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1999-07-01</date><risdate>1999</risdate><volume>34</volume><issue>1</issue><spage>55</spage><epage>61</epage><pages>55-61</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>OBJECTIVES
The purpose of this study was to determine factors correlating with the risk of postoperative mortality after transmyocardial laser revascularization (TMR).
BACKGROUND
Clinical studies have indicated that TMR reduces angina by an average of two classes in patients with medically refractory symptoms not treatable by coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty. Factors which correlate with mortality after TMR, however, have not been extensively investigated.
METHODS
One hundred thirty-two patients with severe angina underwent TMR as sole therapy with a CO2laser. Age, gender, ejection fraction, prior CABG, unstable angina and the severity of coronary artery disease (graded on the basis of a newly proposed Anatomic Myocardial Perfusion index, AMP) were each determined. Each vascular territory (left anterior descending artery [LAD] left circumflex artery and posterior descending artery [PDA]) was graded as either having (AMP = 1) or not having (AMP = 0) blood flow through an unobstructed major vessel in the territory. Univariate and multivariate analysis determined which factors correlated with mortality.
RESULTS
Patients with at least one AMP = 1 vascular territory (overall AMP = 1) had a 5% (4/82) postoperative mortality rate (POM), compared with 25% (12/49) with overall AMP 0 (p = 0.002). Left anterior descending artery AMP (p = 0.03) and previous CABG (p = 0.04) each correlated with the risk of POM. However, multivariate analysis indicated that no factor improved the correlation obtained with overall AMP by itself. With regard to overall mortality (Kaplan-Meier curves), univariate analysis also revealed correlations with overall AMP (p < 0.001), LAD AMP (p = 0.005), previous CABG (p = 0.003) and PDA AMP (p = 0.05) each individually correlated with mortality. Multivariate analysis indicated that overall AMP = 1, female gender and previous CABG together correlated best with lower postoperative mortality.
CONCLUSIONS
Patients with good blood flow to at least one region of the heart through a native artery or a patent vascular graft have a markedly reduced risk of perioperative and longer term mortality.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10399992</pmid><doi>10.1016/S0735-1097(99)00162-X</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of the American College of Cardiology, 1999-07, Vol.34 (1), p.55-61 |
| issn | 0735-1097 1558-3597 |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Angina Pectoris - mortality Angina Pectoris - surgery Biological and medical sciences Diseases of the cardiovascular system Female Humans Laser Therapy Male Medical sciences Middle Aged Myocardial Revascularization - methods Odds Ratio Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Retrospective Studies Risk Factors Treatment Outcome |
| title | Factors correlating with risk of mortality after transmyocardial revascularization |
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