Prognostic Significance of Coronary Collaterals in Patients With Coronary Heart Disease Having Percutaneous Transluminal Coronary Angioplasty

Koerselman, Jeroen; Jaegere, Peter P.T. de; Verhaar, Marianne C.; Grobbee, Diederick E.; Graaf, Yolanda van der

doi:10.1016/j.amjcard.2005.03.083

Cited by 21 publications

(19 citation statements)

References 12 publications

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“…Other very recent investigations in patients with chronic CAD undergoing PCI have included insufficient numbers of individuals with brief observation times, so the number of the only indisputable end point, all-cause mortality, has been Ͻ10. 10,11 Thus, the present investigation is unique in demonstrating that a well-developed collateral circulation reduces all-cause annual mortality from 2.3% (group with low CFI) to a level reached by individuals without CAD (0.6%). In this context, mortality in the presence of well-developed collaterals continues to be diminished beyond a follow-up of 5 years (Figure 3), which can be explained by the increasing importance of natural bypasses during the progression of CAD.…”

Section: Meier Et Al Collateral Flow and Survival 979mentioning

confidence: 73%

“…5,8,9,11,12,16,26 However, as in earlier investigations, 7,15,27-29 the focus has been on widely varying aspects of the terms "prognosis" and "ischemic heart disease" such as surrogate end points for worse outcome in the course of CAD, "soft " and "firmer" cardiac end points, respectively, and the setting of acute myocardial infarction versus chronic stable CAD. Thus, the ongoing controversy over whether coronary collateral vessels are protective against future adverse events is substantially influenced by the solidity of the definition of the terms "prognosis" and "collateral supply."…”

Section: Coronary Collateral Circulation and Adverse Eventsmentioning

confidence: 99%

“…9,10 Conversely, a study performed in a population with more extended CAD has found that the angiographic presence of collaterals may mark an unfavorable prognosis. 11 In the setting of acute myocardial infarction treated by primary percutaneous coronary intervention (PCI), there have…”

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confidence: 99%

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Beneficial Effect of Recruitable Collaterals

et al. 2007

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Background— The prognostic relevance of the collateral circulation is still controversial. The goal of this study was to assess the impact on survival of quantitatively obtained, recruitable coronary collateral flow in patients with stable coronary artery disease during 10 years of follow-up. Methods and Results— Eight-hundred forty-five individuals (age, 62±11 years), 106 patients without coronary artery disease and 739 patients with chronic stable coronary artery disease, underwent a total of 1053 quantitative, coronary pressure–derived collateral measurements between March 1996 and April 2006. All patients were prospectively included in a collateral flow index (CFI) database containing information on recruitable collateral flow parameters obtained during a 1-minute coronary balloon occlusion. CFI was calculated as follows: equation where P occl is mean coronary occlusive pressure, P ao is mean aortic pressure, and CVP is central venous pressure. Patients were divided into groups with poorly developed (CFI <0.25) or well-grown collateral vessels (CFI ≥0.25). Follow-up information on the occurrence of all-cause mortality and major adverse cardiac events after study inclusion was collected. Cumulative 10-year survival rates in relation to all-cause deaths and cardiac deaths were 71% and 88%, respectively, in patients with low CFI and 89% and 97% in the group with high CFI ( P =0.0395, P =0.0109). Through the use of Cox proportional hazards analysis, the following variables independently predicted elevated cardiac mortality: age, low CFI (as a continuous variable), and current smoking. Conclusions— A well-functioning coronary collateral circulation saves lives in patients with chronic stable coronary artery disease. Depending on the exact amount of collateral flow recruitable during a brief coronary occlusion, long-term cardiac mortality is reduced to one fourth compared with the situation without collateral supply.

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Section: Meier Et Al Collateral Flow and Survival 979mentioning

confidence: 73%

Section: Coronary Collateral Circulation and Adverse Eventsmentioning

confidence: 99%

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Beneficial Effect of Recruitable Collaterals

et al. 2007

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“…Also the detection of collateral channels originating from the contralateral epicardial vessel could be helpful for procedure planning, if a retrograde approach is desired [27]. Conversely, the presence of local collaterals is associated with a lower success rate of PCI and these patients are more likely to undergo CABG [7,28].…”

Section: Discussionmentioning

confidence: 99%

Assessment of the presence and extent of coronary collateralization by coronary computed tomographic angiography in patients with total occlusions

Rieber

Sheth

Mooyaart

et al. 2008

Int J Cardiovasc Imaging

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Coronary computed tomography angiography (CTA) may be helpful to manage patients with chronic coronary occlusions. The aim of this study was to determine the sensitivity and specificity of CTA to detect the presence and extent of coronary collaterals as compared to invasive coronary angiography (ICA). We retrospectively evaluated 26 patients who underwent both coronary CTA and ICA within 3 weeks and demonstrated a total coronary occlusion (TIMI grade 0) in one of the major coronary arteries. CTA was performed using a 64-slice multidetector CT. The presence, and extent of collateralization was assessed by two blinded observers using the Rentrop classification for ICA. CTA accurately identified the presence and location of all 26 total occlusions. The presence of any collaterals was accurately detected in 21/23 patients [sensitivity 91% (CI: 71-98%)] and the absence in three patients [specificity 100% (CI: 29%-100%)]. The sensitivity of coronary CTA to identify patients with collateralization increased from 91 to 94% (CI: 71-99%) and 100% (CI: 59-100%) for collaterals Rentrop grade 2 and 3 in ICA, respectively. Coronary CTA accurately detects the presence of any coronary collateralization in patients with total occlusions. Although CT technology is currently limited in the assessment of individual collaterals and smaller vessels, it may be helpful in the management of patients with total occlusions.

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“…Currently available data in these patient groups have so far failed to demonstrate a beneficial effect of collateral circulation [16][17][18][19]. One explanation for such findings may be that the benefit exerted by collaterals was obscured by the harm from extensive atherosclerotic burden.…”

Section: Prognostic Effect Of Coronary Collaterals May Be Altered By mentioning

confidence: 99%

Coronary collaterals—insights in molecular determinants and prognostic relevance

Regieli¹,

Nathoe²,

Koerselman³

et al. 2007

International Journal of Cardiology

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Prognostic Significance of Coronary Collaterals in Patients With Coronary Heart Disease Having Percutaneous Transluminal Coronary Angioplasty

Cited by 21 publications

References 12 publications

Beneficial Effect of Recruitable Collaterals

Beneficial Effect of Recruitable Collaterals

Assessment of the presence and extent of coronary collateralization by coronary computed tomographic angiography in patients with total occlusions

Coronary collaterals—insights in molecular determinants and prognostic relevance

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