Patient Selection

Patient Population

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

Patient Selection

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 2/3^rd of left ventricle (≥ 10% reversibility of perfusion defect)
Incomplete revascularization
Profound physical limitations due to severe angina that produces patient/physician sense of hopelessness
Diabetes

Patient Exclusion

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

Patient Selection Presentation

References

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.