Influence of coronary collateral flow on restenosis following primary angioplasty for acute myocardial infarction

Lee, Cheol Whan; Hong, Myeong Ki; Choi, Si Wan; Kim, June Hong; Kim, Jae Joong; Park, Seong Wook; Park, Seung Jung

doi:10.1002/ccd.10097

Cited by 7 publications

(12 citation statements)

References 19 publications

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“…A total of 123 articles were reviewed and 7 studies including 1,425 patients satisfied the predetermined inclusion criteria (Figure 1) [5,6,20-24]. The study of Wahl et al has been published as a retrospective case-control study [25].…”

Section: Resultsmentioning

confidence: 99%

“…Specifically, excluding the only unpublished data included in this analysis (based on Wahl et al [25]) did not change the overall RR estimate (RR 1.43 (95% CI 1.07 to 1.91); P = 0.016 (heterogeneity: tau 2 = 0.074; I 2 = 60.1%, P = 0.028)). When considering studies with highest quality only (based on the Newcastle-Ottawa Scale; at least seven of eight points), the estimate for RR for restenosis for the group with good collaterals was very consistent but did not reach statistical significance (1.47 (95% CI 0.78 to 2.76); P = 0.235 (heterogeneity: tau 2 < 0.001; I 2 = 0%, P = 0.866)); three studies were considered in this analysis [5,6,24]. …”

Section: Resultsmentioning

confidence: 99%

“…There is strong evidence that the CCC has a positive impact on survival [3,4]. However, some data suggested an increased risk for restenosis following percutaneous coronary intervention (PCI) in patients with good collateralization; however, the findings derive from small studies and have been rather inconsistent [5,6]. The purpose of this systematic review and meta-analysis was to integrate all available data in order to provide a clearer understanding of the impact of the coronary collateral on the risk for restenosis following PCI.…”

Section: Introductionmentioning

confidence: 99%

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Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

Meier

Indermuehle

Pitt

et al. 2012

BMC Med

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BackgroundThe benefit of the coronary collateral circulation (natural bypass network) on survival is well established. However, data derived from smaller studies indicates that coronary collaterals may increase the risk for restenosis after percutaneous coronary interventions. The purpose of this systematic review and meta-analysis of observational studies was to explore the impact of the collateral circulation on the risk for restenosis.MethodsWe searched the MEDLINE, EMBASE and ISI Web of Science databases (2001 to 15 July 2011). Random effects models were used to calculate summary risk ratios (RR) for restenosis. The primary endpoint was angiographic restenosis > 50%.ResultsA total of 7 studies enrolling 1,425 subjects were integrated in this analysis. On average across studies, the presence of a good collateralization was predictive for restenosis (risk ratio (RR) 1.40 (95% CI 1.09 to 1.80); P = 0.009). This risk ratio was consistent in the subgroup analyses where collateralization was assessed with intracoronary pressure measurements (RR 1.37 (95% CI 1.03 to 1.83); P = 0.038) versus visual assessment (RR 1.41 (95% CI 1.00 to 1.99); P = 0.049). For the subgroup of patients with stable coronary artery disease (CAD), the RR for restenosis with 'good collaterals' was 1.64 (95% CI 1.14 to 2.35) compared to 'poor collaterals' (P = 0.008). For patients with acute myocardial infarction, however, the RR for restenosis with 'good collateralization' was only 1.23 (95% CI 0.89 to 1.69); P = 0.212.ConclusionsThe risk of restenosis after percutaneous coronary intervention (PCI) is increased in patients with good coronary collateralization. Assessment of the coronary collateral circulation before PCI may be useful for risk stratification and for the choice of antiproliferative measures (drug-eluting stent instead bare-metal stent, cilostazol).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

Meier

Indermuehle

Pitt

et al. 2012

BMC Med

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“…The degree of collateralisation was estimated from visual assessment [89, 90] or determined by CFI [83, 91, 93] and based on data in the acute [88, 90, 91] or stable setting of CAD [83, 89, 92, 93]. Invariably, the number of patients in these studies were small and the findings rather inconsistent [91, 93]. …”

Section: Vascular Resistance Distributionmentioning

confidence: 99%

Pathophysiology of Coronary Collaterals

Stoller¹,

Seiler

2014

CCR

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While the existence of structural adaptation of coronary anastomoses is undisputed, the potential of coronary collaterals to be capable of functional adaptation has been questioned. For many years, collateral vessels were thought to be rigid tubes allowing only limited blood flow governed by the pressure gradient across them. This concept was consistent with the notion that although collaterals could provide adequate blood flow to maintain resting levels, they would be unable to increase blood flow sufficiently in situations of increased myocardial oxygen demand.However, more recent studies have demonstrated the capability of the collateral circulation to deliver sufficient blood flow even during exertion or pharmacologic stress. Moreover, it has been shown that increases in collateral flow could be attributed directly to collateral vasomotion.This review summarizes the pathophysiology of the coronary collateral circulation, ie the functional adapation of coronary collaterals to acute alterations in the coronary circulation.

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“…5 6 All these studies have relied on a dichotomous angiographic definition of restenosis, which is relatively insensitive and thus may obscure potentially important associations. [7][8][9] Furthermore, in many of these reports, angiographic follow up was limited to symptomatic patients, which in turn may have introduced substantial bias. We have carried out a prospective study to evaluate the potential association between collateral flow and restenosis by using ideal standard techniques to characterise both processes.…”

mentioning

confidence: 99%

Does a well developed collateral circulation predispose to restenosis after percutaneous coronary intervention? An intravascular ultrasound study

Perera

Postema²,

Rashid³

et al. 2005

Heart

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Objective: To evaluate whether a well developed collateral circulation predisposes to restenosis after percutaneous coronary intervention (PCI). Design: Prospective observational study. Patients and setting: 58 patients undergoing elective single vessel PCI in a tertiary referral interventional cardiac unit in the UK. Methods: Collateral flow index (CFI) was calculated as (P w 2 P v )/(P a 2 P v ), where P a , P w , and P v are aortic, coronary wedge, and right atrial pressures during maximum hyperaemia. Collateral supply was considered poor (CFI , 0.25) or good (CFI > 0.25). Main outcome measures: In-stent restenosis six months after PCI, classified as neointimal volume > 25% stent volume on intravascular ultrasound (IVUS), or minimum lumen area ( 50% stent area on IVUS, or minimum lumen diameter ( 50% reference vessel diameter on quantitative coronary angiography. Results: Patients with good collaterals had more severe coronary stenoses at baseline (90 (11)% v 75 (16)%, p , 0.001). Restenosis rates were similar in poor and good collateral groups (35% v 43%, p = 0.76 for diameter restenosis, 27% v 45%, p = 0.34 for area restenosis, and 23% v 24%, p = 0.84 for volumetric restenosis). CFI was not correlated with diameter, area, or volumetric restenosis (r 2 , 0.1 for each). By multivariate analysis, stent diameter, stent length, . 10% residual stenosis, and smoking history were predictive of restenosis. Conclusion: A well developed collateral circulation does not predict an increased risk of restenosis after PCI.T he potential of coronary collaterals to abrogate myocardial ischaemia and limit infarction has long been established. 2Similarly, a well developed collateral circulation appears to predict an improved clinical outcome after percutaneous coronary intervention (PCI). When a dichotomous collateral flow index (CFI) threshold of 0.25 is used to distinguish between good and poor collateral supply, patients with inadequate collateral protection have been shown to have a four-to eightfold increase in the rate of death, myocardial infarction, or unstable angina after PCI compared with those with adequate collaterals.3 4 In contrast to the beneficial association between coronary collaterals and clinical sequelae, the impact of collateral flow at the time of PCI on subsequent restenosis remains controversial. Several retrospective studies have suggested that good collateral flow is a risk factor for restenosis.5-7 It has been postulated that this may be due to reduced antegrade flow in the target vessel caused by competitive flow through persistent collateral channels. More recent reports have failed to reproduce these findings. Much of this controversy may relate to the methods used in these studies. In early reports, the collateral circulation was characterised by coronary wedge pressure (P w ) or angiographically visible channels, which are imprecise techniques and have largely been superseded. 5 6 All these studies have relied on a dichotomous angiographic definition of restenosis, which is relatively insensit...

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Influence of coronary collateral flow on restenosis following primary angioplasty for acute myocardial infarction

Cited by 7 publications

References 19 publications

Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

Pathophysiology of Coronary Collaterals

Does a well developed collateral circulation predispose to restenosis after percutaneous coronary intervention? An intravascular ultrasound study

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