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In a contemporary series of patients with CAD, 28.8% had incomplete revascularization.1 The mortality of patients with diffuse CAD and incomplete revascularization is a significant clinical issue as mortality rates are more than double for this group of patients. 1 Furthermore, these patients have a higher incidence of major adverse cardiac events2 and decreased quality of life(QoL)1. In all, some 100,000 – 200,000 patients per year may be eligible for new revascularization techniques.3
If you answering yes to any of the following, your patient may benefit from TMR:
- Stable patient with severe angina CCS Class IV, refractory to medical management
- Regions of the myocardium demonstrating reversible ischemia which are not amenable to direct coronary revascularization (either PCI or CABG)
- Patients with one or more vessels or branches that are not bypassable (small vessels 1.0 – 1.5 mm diameter or less may be indicators)
- Diffuse Distal Coronary Artery Disease (diffuse atherosclerotic end-stage disease)
- Left ventricular ejection fraction ≥ 30%
- Area of ischemia located in lower 2/3rd of left ventricle (≥ 10% reversibility of perfusion defect)
- Incomplete revascularization
- Profound physical limitations due to severe angina that produces patient/physician sense of hopelessness
TMR will not improve or treat any of the following:
- Not a treatment for congestive heart failure
- Does not improve shortness of breath (dyspnea) unrelated to angina
- Will not improve a failing pump
- Q-wave MI within past 3 weeks
- Non Q-wave MI within past 2 weeks
- Severely unstable patients (unweanable from I.V. anti-anginal medication)
- Uncontrolled ventricular tachy-arrhythmia
- Cardiac failure, decompensated
- Williams B, et al. Catheter Cardiovasc Interv 2010;75:886-891.
- Andrell P, et al. Int J Cardiol 2011;147:377-82.
- Mukherjee D, et al. Am J Cardiol 1999;84:598-600.