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From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes.

Publication ,  Journal Article
Peterson, ED; Kaul, P; Kaczmarek, RG; Hammill, BG; Armstrong, PW; Bridges, CR; Ferguson, TB; Society of Thoracic Surgeons,
Published in: J Am Coll Cardiol
November 5, 2003

OBJECTIVES: We sought to examine trends in the use and outcomes of transmyocardial revascularization (TMR) in community practice. We also identified important risk factors for TMR and compared outcomes of TMR combined with coronary artery bypass graft surgery (TMR + CABG) versus bypass alone in patients receiving incomplete revascularization. BACKGROUND: Although it is approved for use as a stand-alone procedure, there are limited data on the outcomes of (TMR + CABG). METHODS: We identified 3,717 patients receiving TMR at 173 U.S. hospitals participating in the Society of Thoracic Surgeons (STS) National Cardiac Database. Baseline characteristics and outcomes in these patients were compared with those from six published randomized TMR trials. Multivariable logistic regression was used to identify clinical risk factors for mortality with TMR. Risk-adjusted mortality was also compared for TMR + CABG relative to CABG only in patients not amenable to complete traditional revascularization. RESULTS: Between January 1998 and December 2001, the number of STS hospitals performing TMR and total procedural counts increased markedly, driven predominately by more TMR + CABG cases. Overall mortality rates for TMR-alone and TMR + CABG were 6.4% and 4.2%, respectively. Operative risks were significantly higher in those patients with recent myocardial infarction, unstable angina, and depressed ventricular function. Among patients receiving incomplete revascularization, TMR + CABG was not associated with decreased mortality risk compared with CABG alone, adjusted odds ratio 1.11 (95% confidence interval 0.74 to 1.67). CONCLUSIONS: The use of TMR, and in particular, TMR + CABG, is expanding in community practice. Although procedural risks are high, there is room for optimization through improved patient selection and timing of the procedure. Further studies of TMR + CABG are needed given its growing use and unclear benefits.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

November 5, 2003

Volume

42

Issue

9

Start / End Page

1611 / 1616

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Registries
  • Practice Patterns, Physicians'
  • Myocardial Revascularization
  • Multicenter Studies as Topic
  • Middle Aged
  • Male
  • Logistic Models
  • Laser Therapy
 

Citation

APA
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ICMJE
MLA
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Peterson, E. D., Kaul, P., Kaczmarek, R. G., Hammill, B. G., Armstrong, P. W., Bridges, C. R., … Society of Thoracic Surgeons, . (2003). From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes. J Am Coll Cardiol, 42(9), 1611–1616. https://doi.org/10.1016/j.jacc.2003.07.003
Peterson, Eric D., Padma Kaul, Ronald G. Kaczmarek, Bradley G. Hammill, Paul W. Armstrong, Charles R. Bridges, T Bruce Ferguson, and T Bruce Society of Thoracic Surgeons. “From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes.J Am Coll Cardiol 42, no. 9 (November 5, 2003): 1611–16. https://doi.org/10.1016/j.jacc.2003.07.003.
Peterson ED, Kaul P, Kaczmarek RG, Hammill BG, Armstrong PW, Bridges CR, et al. From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes. J Am Coll Cardiol. 2003 Nov 5;42(9):1611–6.
Peterson, Eric D., et al. “From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes.J Am Coll Cardiol, vol. 42, no. 9, Nov. 2003, pp. 1611–16. Pubmed, doi:10.1016/j.jacc.2003.07.003.
Peterson ED, Kaul P, Kaczmarek RG, Hammill BG, Armstrong PW, Bridges CR, Ferguson TB, Society of Thoracic Surgeons. From controlled trials to clinical practice: monitoring transmyocardial revascularization use and outcomes. J Am Coll Cardiol. 2003 Nov 5;42(9):1611–1616.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

November 5, 2003

Volume

42

Issue

9

Start / End Page

1611 / 1616

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Registries
  • Practice Patterns, Physicians'
  • Myocardial Revascularization
  • Multicenter Studies as Topic
  • Middle Aged
  • Male
  • Logistic Models
  • Laser Therapy