The impact of the coronary collateral circulation on mortality: a meta-analysis

Meier, Pascal; Hemingway, Harry; Lansky, Alexandra J.; Knapp, Guido; Pitt, Bertram; Seiler, Christian

doi:10.1093/eurheartj/ehr308

Cited by 236 publications

(194 citation statements)

References 30 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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“…A meta-analysis by Meier et al showed that the presence of collaterals in patients with ischemic heart disease reduced mortality [29]. According to W. Schaper, who commented on the above meta-analysis, if the prognosis in patients with collaterals is better than with CABG, and maybe even stenting, then there is a chance for improved prognosis for the patients in whom heart failure progresses when other treatment options have been exhausted [30].…”

Section: Discussionmentioning

confidence: 99%

Expression of Proinflammatory Factors, Proangiogenic Factors and Endostatin in Patients with Heart Failure and Different Grades of Collateral Circulation Development

Kobusiak−Prokopowicz¹,

Jołda-Mydłowska²,

Grzebieniak³

et al. 2015

Adv Clin Exp Med

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“…Unfortunately, however, not all of the incorporated studies in the current meta-analysis reported Rentrop scores or reported on diameter stenosis. For example, Meier et al [2], Elsman et al [6] and Sorajja et al [1] used positive blush grades instead of Rentrop flow grading. Therefore, we were unable to assess Rentrop scores in relation to disease severity.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary collateral circulation has been shown to have a significant protective effect on myocardial viability in animal models, but its functional significance and the general impact on mortality in humans is still controversial [1,2]. The role of coronary collateral circulation to the myocardium at risk in the setting of coronary artery disease (CAD) and acute coronary occlusion has been of special interest in the last decades.…”

Section: Introductionmentioning

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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The impact of the coronary collateral circulation on mortality: a meta-analysis

Abstract: In patients with CAD, the coronary collateralization has a relevant protective effect. Patients with a high collateralization have a 36% reduced mortality risk compared with patients with low collateralization.

Cited by 236 publications

References 30 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

Expression of Proinflammatory Factors, Proangiogenic Factors and Endostatin in Patients with Heart Failure and Different Grades of Collateral Circulation Development

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

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