Coronary collaterals during single‐vessel coronary angioplasty: Effects of nitroglycerin

Eriksen, Ulrik; Nielsen, Torsten Toftegaard; Egeblad, Henrik; Bagger, Jens Peder

doi:10.1002/clc.4950250707

Cited by 7 publications

(3 citation statements)

References 16 publications

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“…[25][26][27][28] In a study of 450 patients, Pohl and colleagues 25 observed that percent diameter stenosis of a coronary artery was the only independent predictor of CFI in the corresponding territory, although the association was relatively weak (rϭ0.10). We have demonstrated an even stronger correlation between CFI and anatomic and functional stenosis severity at the time of PCI that supports the concept that collateral development may be promoted by chronic myocardial ischemia.…”

Section: Determinants Of Collateral Supplymentioning

confidence: 99%

Coronary Collaterals Remain Recruitable After Percutaneous Intervention

et al. 2007

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Background-Rapid loss of collateral support has been reported after percutaneous coronary intervention (PCI), leaving the myocardium susceptible to subsequent infarction. However, well-developed collaterals have been found in normal hearts, suggesting that collaterals exist even in the absence of an ischemic stimulus. We assessed the plasticity and determinants of collateral supply after PCI. Methods and Results-Collateral flow index (CFI) was calculated in 60 patients as (P w ϪP v )/(P a ϪP v ) by measurement of aortic (P a ), central venous (P v ), and coronary wedge (P w ) pressures. CFI was reassessed during transient balloon occlusion 5 minutes and 24 hours after PCI in the first 29 patients and at 6 months in the subsequent 25 patients. We also evaluated the relationship between collateral supply, lesion characteristics, and circulating hemopoietic cells numbers before and after successful PCI. CFI at baseline was 0.23Ϯ0.10, with no change 5 minutes and 1 day later (0. 21Ϯ0.12, Pϭ0.62; and 0.22Ϯ0.11, Pϭ0.96, respectively). At 6 months, CFI was 0.14Ϯ0.07 or 63Ϯ27% of the baseline value (PϽ0.001). CFI was proportional to severity of the coronary lesion at baseline (rϭ0.63, PϽ0.0001) but not 6 months after PCI (rϭϪ0.04, Pϭ0.87). The number of circulating CD133 ϩ and CD34 ϩ cells was associated with CFI 6 months after PCI (CD133, rϭ0.59, Pϭ0.035; CD34, rϭ0.63, Pϭ0.037). Conclusions-Coronary collateral flow remains undiminished for at least 24 hours after successful PCI. Functional collateral support subsequently declines but does not regress completely.

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Section: Determinants Of Collateral Supplymentioning

confidence: 99%

Coronary Collaterals Remain Recruitable After Percutaneous Intervention

et al. 2007

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“…Several risk factors associated with PMI after off-pump CABG were reported. The presence of collaterals could protect the patients against PMI [11]. We found that the risk of PMI was associated with increasing the number of distal anastomoses.…”

Section: Discussionmentioning

confidence: 74%

Predictors of perioperative myocardial infarction in patients undergoing off-pump coronary artery bypass grafting

Amr

Fayad

2022

Cardiothorac Surg

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Background Perioperative myocardial infarction (PMI) increases morbidity and mortality after off-pump coronary artery bypass grafting (CABG). The objective of the current study was to characterize patients with PMI after off-pump CABG and identify its predictors. Results We included 1181 patients who had off-pump CABG from 2010 to 2020; 59 patients (5%) had PMI. We compared patients with PMI to those without PMI. Patients with PMI were older (57 (25th–75th percentiles: 51–63) vs. 54 (48–60) years; P = 0.01) and had higher NYHA class (28 (47.46%) vs. 326 (29.06%): P = 0.01). The distal anastomosis time was longer in patients with PMI (28 (23–35) vs. 24 (16–30) min; P ˂ 0.001). Patients with PMI had higher postoperative low cardiac output (10 (18.18%) vs. 1 (0.1%): P ˂ 0.001), prolonged ventilation (12 (8–39) vs. 8 (6–10) h, P ˂ 0.001), ICU (71 (46–138) vs. 24 (23–42) h; P ˂ 0.001), and hospital stay (9 (6–15) vs. 7 (6–8) days; P ˂ 0.001). Mortality was significantly higher in patients with PMI (20 (33.9%) vs. 6 (0.53%); P ˂ 0.001). Older age (OR: 1.05 (95% CI: 1.01–1.1); P = 0.02), increased number of distal anastomoses (OR: 1.74 (95% CI: 1.20–2.50); P = 0.003), preoperative congestive heart failure (OR: 10.27 (95% CI: 2.58–40.95); P = 0.001), and thrombolysis within 24 h of surgery (OR: 15.34 (1.93–121.9); P = 0.01) were associated with increased PMI, while PMI was lower in male patients (OR: 0.42 (95% CI: 0.19–0.93); P = 0.03) and with higher body surface area (BSA) (OR: 0.08 (95% CI: 0.07–0.86); P = 0.04). Conclusions Post-off-pump CABG PMI was associated with increased morbidity and mortality. Risk factors for PMI were older age, lower BSA, females, increased distal anastomoses, preoperative heart failure, and thrombolysis.

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“…Grade 0 means no visible collaterals, grade 1 means collateral filling without epicardial segment visualization, grade 2 means partial epicardial filling, and grade 3 means complete epicardial filling [15]. In some cases, post-MI angiogenesis may help construct collateral flow to the damaged myocardium, or in the case of preexisting collateral flow, increase it [14,16,17]. Thus, in patients whose first MPS revealed nonviable myocardium, a secondary MPS to assess viability may be beneficial and alter the course of treatment strategies, making a revascularization procedure to be necessary [18].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of myocardial viability by a secondary delayed 99mTc-MIBI nuclear scanning in ST-elevation myocardial infarction patients with delay in referral and nonviable myocardium in the first scintigraphy: a preliminary cohort study

Farsavian,

Ghadirzadeh,

Yazdani Charati

et al. 2023

Nuclear Medicine Communications

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Objective In the management of ST-segment elevation myocardial infarction (STEMI), if the treatment has not been initiated within the first 24 h and the patient no longer exhibits any symptoms, the decision to begin revascularization therapy is based on myocardial viability. If the tissue is nonviable, current guidelines advise against further revascularization therapy; however, collateral vessels represent an alternative source of blood supply and may help the damaged tissue to resume function; though at first, this tissue may not be considered viable. Thus, in patients whose first myocardial perfusion scintigraphy (MPS) revealed nonviable myocardium, a secondary MPS to assess viability may be beneficial and alter the course of treatment strategies. Methods This prospective cohort study was conducted on 30 STEMI patients referred to Mazandaran Heart Center. If no myocardial viability was found using 99mTc-MIBI MPS, the patient was referred for a secondary MPS after 3 months. Results In total, out of 30 patients, 3 became viable. There was no significant relationship between the viability of different Rentrop classes. Comparison of viability between patients with different numbers of occluded vessels showed no significant relationship. Three patients (17%) among 17 patients with Rentrop class nonzero became viable in the second MPS. Also, among four patients (13.3%) with Rentrop class three, one patient (25%) became viable and among seven patients (23.3%) with Rentrop class one, two patients (28.6%) became viable. Conclusion Considering the results of this study, although nonsignificant, this subject requires further investigation to reach a definite conclusion.

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Coronary collaterals during single‐vessel coronary angioplasty: Effects of nitroglycerin

Cited by 7 publications

References 16 publications

Coronary Collaterals Remain Recruitable After Percutaneous Intervention

Coronary Collaterals Remain Recruitable After Percutaneous Intervention

Predictors of perioperative myocardial infarction in patients undergoing off-pump coronary artery bypass grafting

Evaluation of myocardial viability by a secondary delayed 99mTc-MIBI nuclear scanning in ST-elevation myocardial infarction patients with delay in referral and nonviable myocardium in the first scintigraphy: a preliminary cohort study

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