Who is a candidate for TMR and PMR?
TMR may be considered for people who suffer from chronic stable angina and do not respond to treatment with medication. It is performed only in people who cannot have the standard treatments for this condition: angioplasty or bypass surgery.2, 5 Angioplasty and bypass surgery may not be possible if there are too many blockages in the arteries (the heart disease has progressed to such a stage that the arteries cannot be repaired by one of these treatments). Additionally, some people's arteries are too small to fit the catheter used in angioplasty. In some cases, bypass surgery and TMR are performed at the same time if there are some blockages that can be treated with bypass surgery but others that can't. If your physician has told you that there is nothing else that can be done to improve your chest pain, TMR may be an option. TMR may also be appropriate if you need a repeat bypass surgery or angioplasty but are at high risk for serious complications.
PMR is rarely performed, except in experimental trials, because it has not been shown to have the same benefits as TMR.
Who should not have TMR?
If you have chronic stable angina, but your pain is being relieved with medication or you are able to have angioplasty or bypass surgery, you should not have TMR. These other treatments are known to decrease chest pain and reduce the risk of future heart problems.
Certain factors have been found that increase a person's risk for problems and dying after TMR. One study found that diabetes put people at a greater risk for a heart attack or dying from a heart-related cause shortly after the procedure.9 People who have peripheral vascular disease (disease in the blood vessels of the arms or legs) or had a previous bypass surgery have a higher risk of dying during or just after TMR.10
