Beneficial effect of recruitable collaterals : A 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements

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. Eight-hundred fort...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 2007-08, Vol.116 (9), p.975-983
Main Authors: MEIER, Pascal, GLOEKLER, Steffen, WENAWESER, Peter, TOGNI, Mario, WINDECKER, Stephan, MEIER, Bernhard, SEILER, Christian, ZBINDEN, Rainer, BECKH, Sarah, DE MARCHI, Stefano F, ZBINDEN, Stephan, WUSTMANN, Kerstin, BILLINGER, Michael, VOGEL, Rolf, COOK, Stéphane
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Biomarkers - blood
Blood and lymphatic vessels
Blood Pressure
Cardiology. Vascular system
Cardiovascular system
Collateral Circulation - physiology
Coronary Angiography
Coronary Disease - diagnostic imaging
Coronary Disease - mortality
Coronary Disease - physiopathology
Coronary heart disease
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Electrocardiography
Female
Follow-Up Studies
Heart
Humans
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Prognosis
Survival Analysis
Time Factors
Treatment Outcome
Vasodilator agents. Cerebral vasodilators
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Summary: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. 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: CFI = (P(occl) - CVP)/(P(ao) - CVP) 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 > or = 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. 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.
ISSN:0009-7322
1524-4539
DOI:10.1161/CIRCULATIONAHA.107.703959