Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction

Antoniucci, David; Valenti, Renato; Moschi, Guia; Migliorini, Angela; Trapani, Maurizio; Santoro, Giovanni Maria; Bolognese, Leonardo; Cerisano, Giampaolo; Buonamici, Piergiovanni; Dovellini, Emilio Vincenzo

doi:10.1016/s0002-9149(01)02186-5

Cited by 115 publications

(87 citation statements)

References 13 publications

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“…30 However, studies in which collateral extent and function are studied as prognostic determinants of vascular outcome are hardly available. Only recently, Antoniucci et al 35 published a study on the significance of preintervention angiographic evidence of coronary collateral circulation in patients with acute MI who underwent primary angioplasty or stenting within 6 hours of symptom onset. At 6 months, the mortality rate was lower in patients with coronary collateral circulation compared with patients without collaterals, without clear effects on clinical outcomes.…”

Section: Growth Factorsmentioning

confidence: 99%

Coronary Collaterals

et al. 2003

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Section: Growth Factorsmentioning

confidence: 99%

Coronary Collaterals

et al. 2003

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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: 72%

“…Although the exact mechanisms underlying the protective effects of the presence of collaterals are unclear, several factors might play a role. The collateral circulation has demonstrated clinical benefit regarding smaller infarct size, preservation of cardiac function after acute (re-) infarctions, and reduction in post-infarct ventricular dilatation [14][15][16][17][18][19][20][21][22]. Following a total coronary occlusion, residual perfusion to the myocardium persists through native coronary collaterals that open when an intercoronary pressure gradient between the source and recipient vessel develops.…”

Section: Discussionmentioning

confidence: 99%

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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“…However, the relation between well-developed coronary collaterals and prognosis had not been fully assessed. In a published study by Antoniucci et al (11) findings in patients with acute MI, having symptoms onset within 6 hours and underwent primary angioplasty or stenting revealed the importance of preintervention angiographic evidence of coronary collateral circulation. According to results of this study in respect of mortality rates, patients with coronary collateral circulation have lower levels of mortality compared with patients without coronary collaterals but in respect of clinical outcomes the effect of coronary collaterals is unclear.…”

Section: Discussionmentioning

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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Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction

Cited by 115 publications

References 13 publications

Coronary Collaterals

Coronary Collaterals

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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