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CLINICAL STUDY: CORONARY BLOOD FLOW

Frequency distribution of collateral flow and factors influencing collateral channel development

Functional collateral channel measurement in 450 patients with coronary artery disease

^a Division of Cardiology, Swiss Cardiovascular Center of Bern, University Hospital, Bern, Switzerland

Manuscript received June 5, 2001; revised manuscript received August 17, 2001, accepted August 29, 2001.

^* Reprint requests and correspondence: Dr. Christian Seiler, Professor of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland
christian.seiler.cardio{at}insel.ch

OBJECTIVES

We sought to determine the pathogenetic predictors of collateral channels in a large cohort of patients with coronary artery disease (CAD).

BACKGROUND

The frequency distribution of collateral flow in patients with CAD is unknown. Only small qualitative studies have investigated which factors influence the development of collateral channels.

METHODS

In 450 patients with one- to three-vessel CAD undergoing percutaneous transluminal coronary angioplasty (PTCA), collateral flow was measured. A collateral flow index (CFI; no unit) expressing collateral flow relative to normal anterograde flow was determined using coronary wedge pressure or Doppler measurements through sensor-tipped PTCA guide wires. Frequency distribution analysis of CFI and univariate and multivariate analyses of 32 factors, including gender, age, patient history, cardiovascular risk factors, medication and coronary angiographic data, were performed.

RESULTS

Two-thirds of the patients had a CFI <0.25 and 40% of patients had a CFI <0.15, but only 10% of the patients had a recruitable CFI 0.4. By univariate analysis, the following were predictors of CFI 0.25: high levels of high-density lipoprotein cholesterol, the absence of previous non–Q-wave myocardial infarction, angina pectoris during an exercise test, angiographic indicators of severe CAD and the left circumflex or right coronary artery as the collateral-receiving vessel. Percent diameter stenosis of the lesion undergoing PTCA was the only independent predictor of a high CFI.

CONCLUSIONS

This large clinical study of patients with CAD in whom collateral flow was quantitatively assessed reveals that two-thirds of the patients do not have enough collateral flow to prevent myocardial ischemia during coronary occlusion, and that coronary lesion severity is the only independent pathogenetic variable related to collateral flow.

Abbreviations and Acronyms   CAD = coronary artery disease   CFI = collateral flow index   CVP = central venous pressure   LAD = left anterior descending coronary artery   LCx = left circumflex coronary artery   LVEDP = left ventricular end-diastolic pressure   Pao = aortic pressure   Poccl = occlusive pressure (coronary wedge pressure)   PTCA = percutaneous transluminal coronary angioplasty   RCA = right coronary artery

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