Coronary collaterals improve prognosis in patients with ischemic heart disease

Regieli, Jakub J.; Jukema, J. Wouter; Nathoe, Hendrik M.; Zwinderman, Aeilko H.; Ng, Sunanto; Grobbee, Diederick E.; Graaf, Yolanda van der; Doevendans, Pieter A.

doi:10.1016/j.ijcard.2007.11.100

Cited by 69 publications

(54 citation statements)

References 28 publications

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“…Despite the complete interruption of antegrade blood flow caused by heavy atherosclerotic plaque burden or arterial thrombosis, the frequency of myocardial infarction in areas subtended by chronic total occlusion varies considerably (Fefer et al, 2012), and the degree of myocardial injury downstream of epicardial chronic total occlusion is inversely correlated with the degree of angiographic coronary collateral circulation (Choi et al, 2013). Well-developed coronary collaterals have the potential to alleviate myocardial ischemia, preserve residual contractility, reduce cardiovascular events (Regieli et al, 2009;Meier et al, 2012), and even save lives in patients with severe coronary artery occlusion (Meier, 2011). The complex mechanism mediating the development of coronary collateral vessels in the heart is still not well-understood.…”

Section: Introductionmentioning

confidence: 99%

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Sun

Shen

Lü

et al. 2013

J. Zhejiang Univ. Sci. B

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Abstract:Objective: Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion. Methods: Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system. Results: Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high collateralization (for all comparisons, P<0.05). In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein (hsCRP) compared with those with high collateralization. Multivariate analysis revealed that age of ≥65 years, female gender, diabetes, no history of hypertension, dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were independently associated with low coronary collateralization. Conclusions: Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.

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Section: Introductionmentioning

confidence: 99%

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Sun

Shen

Lü

et al. 2013

J. Zhejiang Univ. Sci. B

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“…If this is true, then the atherosclerotic risk factors should be more often present in patient with collaterals than in those without. This is, however, not supported by the rather symmetric pattern of patient characteristics in most studies as metaanalysed in the current study [1,6,9,10,13,[15][16][17][18][19]. To assess this issue in a wider perspective, meta-regression was performed.…”

Section: Discussionmentioning

confidence: 73%

“…Five of them were excluded because no survival data were reported per group. Of the ten studies included [1,3,6,7,[10][11][12][13][14][15] nine studies reported mortality during follow-up of 0.6-9 years, while seven studies reported the composite endpoint of deaths and re-infarctions separately for the subgroups. Baseline clinical characteristics of the included trials are listed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…While the protective effect of collaterals may theoretically be reduced with a more extensive burden of ischaemic heart disease, the impact on cardiovascular risk appears to remain present in patients with marked disease [13]. It has been hypothesised based on small observational studies [14] that atherosclerosis may trigger the formation of coronary collaterals.…”

Section: Discussionmentioning

confidence: 99%

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Effect of collaterals on deaths and re-infarctions in patients with coronary artery disease: a meta-analysis

et al. 2012

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Background It is generally believed that there is a beneficial effect of collaterals on death and re-infarction statistics in patients with coronary artery disease (CAD) but studies to date are small and inconsistent. Objective To meta-analyse the studies published in this field in order to obtain more powerful information. Methods We searched Medline and major journals (2000 to 2011) for studies evaluating the effect of coronary collaterals on mortality. Publication bias, lack of heterogeneity, and lack of robustness were assessed using the standard procedures for such purposes. Results A total of 10 studies describing mortality, enrolling 6791 participants, were included in this analysis. In patients with collateralisation a significant relation with reduced mortality was seen compared with those without collateralisation, at an odds ratio of 0.47, p<0.0001, and a reduction in deaths and re-infarctions at 0.54, p<0.0001. Some publication bias, some heterogeneity and some lack of robustness were demonstrated. A meta-regression with the odds ratios of the presence of traditional atherosclerotic risk factors as predictors and the odds ratios of mortality and the composite deaths and re-infarctions as outcome showed no relationships.Conclusions In CAD patients from the post-percutaneous coronary intervention era the presence of collaterals reduced mortality by 0.47 (p<0.0001) and deaths and re-infarctions by 0.54 (p<0.0001). Furthermore, in the present meta-data, the atherosclerotic risk factors were no more present in patients with collaterals than they were in those without.

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“…They can regress with sufficient coronary perfusion during a relatively short period of time after successful revascularization. The importance of presence of coronary collaterals are defined especially in patients with stable coronary artery disease by presenting of patient better prognosis and statement of a decrease in ischemic events related to coronary circulation (3).…”

Section: Introductionmentioning

confidence: 99%

Survival of patients with well-developed collaterals undergoing CABG or medical treatment: An observational case-controlled study

Tatlı¹,

Aktöz²,

Çakar³

et al. 2012

Anadolu Kardiyol Derg

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Objective: The effects of coronary artery bypass grafting (CABG) on mortality have not been evaluated in patients with well-developed coronary collaterals. We investigated functional capacity, presence of angina, the occurrence of acute myocardial infarction, survival and mortality in patients with well-developed coronary collaterals both undergoing and refusing CABG. Methods: The study was designed as a retrospective observational case-controlled study. Seventy-eight patients undergoing coronary angiography were included in this study. They had critical occlusion in the proximal left anterior descending artery (LAD) with Rentrop-3 collateral circulation towards LAD, and to proceed with CABG has been suggested. The patients were divided in two groups; first group proceeding with CABG (n=40) and the second, rejecting the surgery (medical treatment group; n=38). The rates of survival, the incidence of angina pectoris and acute myocardial infarction as well as the functional capacities were evaluated in all patients. Survival rates were evaluated using Kaplan-Meier survival analysis. Results: No statistically significant difference was observed between the two groups regarding the baseline characteristics of patients, the presence of angina pectoris, the severity of angina pectoris according to CCS, the occurrence of acute myocardial infarction or stroke, and the functional capacity according to NYHA (p>0.05). Death due to cardiovascular reasons was observed in eight patients of CABG group and in five patients of medical treatment group (p=0.710). The 5-year survival rate was observed to be 80% in CABG group while it was observed to be 84% in the medical treatment group (p=0.730). Conclusion: There was no significant difference regarding the survival rates in patients with well-developed coronary collaterals proceeding with CABG or medical treatment. (Anadolu Kardiyol Derg 2012; 12: 97-101) Key words: Coronary collateral circulation, coronary bypass surgery, survival analysis, prognosis 97 ÖZET Amaç: Bugüne kadar, iyi gelişmiş koroner kolaterali olan hastalarda baypas cerrahisinin mortalite üzerine etkisi değerlendirilmedi. Biz iyi geliş-miş kolaterali olan, baypas olmuş ve baypas'ı reddeden hastalar arasında sağkalım, mortalite, fonksiyonel kapasite, angina varlığı ve akut miyokart enfarktüs gelişimini araştırdık. Yöntemler: Çalışma retrospektif, vaka-kontrollü gözlemsel bir çalışma olarak dizayn edildi. Koroner anjiyografi uygulanan, sol ön inen arter proksimalinden tam tıkalı olup, Rentrop-3 kolaterali olan ve baypas ameliyatı önerilen 78 hasta retrospektif olarak çalışmaya alındı. Hastalar baypas'ı kabul eden (Grup1, n=40) ve reddeden (Grup 2, n=38) hastalar olmak üzere iki gruba bölündü. Tüm hastalarda sağkalım, fonksiyonel kapasite, angina varlığı ve akut miyokart enfarktüs gelişimi araştırıldı. Sağkalım oranları Kaplan-Meier sağkalım analizi ile değerlendirildi. Bulgular: İki grup arasında hastaların temel özellikleri, angina varlığı ve şiddeti, fonksiyonel kapasite, akut miyokart enfarktüsü veya inm...

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Coronary collaterals improve prognosis in patients with ischemic heart disease

Cited by 69 publications

References 28 publications

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Effect of collaterals on deaths and re-infarctions in patients with coronary artery disease: a meta-analysis

Survival of patients with well-developed collaterals undergoing CABG or medical treatment: An observational case-controlled study

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