This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Billinger, M. Articles by Seiler, C. Search for Related Content PubMed PubMed Citation Articles by Billinger, M. Articles by Seiler, C.

CLINICAL STUDY: CARDIAC CATHETERIZATION AND INTERVENTION

Physiologically assessed coronary collateral flow and adverse cardiac ischemic events: a follow-up study in 403 patients with coronary artery disease

^* Division of Cardiology, Swiss Cardiovascular Center Bern, Bern, Switzerland

Manuscript received March 11, 2002; revised manuscript received May 14, 2002, accepted June 7, 2002.

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

OBJECTIVES: We sought to evaluate whether coronary collateral flow is clinically relevant for future cardiac ischemic events.

BACKGROUND: The link between good collateral supply related to less myocardial damage and fewer cardiac events has not been established prospectively beyond doubt.

METHODS: In 403 patients with stable angina pectoris undergoing percutaneous transluminal coronary angioplasty (PTCA) and quantitative collateral assessment, the occurrence of major adverse cardiac events ([MACE] cardiac death, myocardial infarction, unstable angina pectoris) and stable angina pectoris was monitored during follow-up. Collateral flow index (CFI) was determined using intracoronary pressure or Doppler guidewires. Mean aortic ([P_ao] mm Hg) and distal coronary artery occlusive pressure ([P_occl] mm Hg) during balloon angioplasty (PTCA), or distal coronary flow velocity time integral during ([V_occl] cm) and after ([V_ø-occl] cm) PTCA were measured continuously. Pressure-derived CFI was calculated as follows: (P_occl – 5)/(P_ao – 5). Doppler-derived CFI: V_occl/V_ø-occl. Patients were subdivided into a group with well (CFI 0.25) and poorly developed collaterals (CFI < 0.25).

RESULTS: Average follow-up was 94 ± 56 (15 to 202) weeks. There were 134 patients with CFI 0.25 (61 ± 11 years) and 269 with CFI <0.25 (61 ± 10 years). The overall cardiac ischemic event rate (MACE and stable angina pectoris) during follow-up was 23% in patients with CFI 0.25 and 20% in patients with CFI <0.25 (p = NS). However, only 2.2% of patients with good collateral flow suffered a major cardiac ischemic event, compared with 9.0% among patients with poorly developed collaterals (p = 0.01). The incidence of stable angina pectoris was significantly higher in patients with well developed collaterals than in those with poorly developed collaterals (21% vs. 12%; p = 0.01).

CONCLUSIONS: In this relatively large population with chronic stable coronary artery disease undergoing quantitative collateral measurement, the beneficial impact of well developed collateral vessels on the occurrence of future major cardiac ischemic events is clearly demonstrated.

Abbreviations and Acronyms   CAD   coronary artery disease   CFI   collateral flow index   CFIP   pressure-derived index of collateral flow   CFIV   velocity-derived index of collateral flow   CVP   central venous pressure   i.c.   intracoronary   MI   myocardial infarct, myocardial infarction   Pao   mean aortic pressure   Poccl   coronary wedge pressure   PTCA   percutaneous transluminal coronary angioplasty   Voccl   ratio of flow velocity time integral distal to the occluded stenosis   Vø-occl   flow velocity time integral during vessel patency

This article has been cited by other articles:

				J. Dieleman, A.-M. Sauer, C. Klijn, H. Nathoe, K. Moons, C. Kalkman, J. Kappelle, and D. Van Dijk Presence of coronary collaterals is associated with a decreased incidence of cognitive decline after coronary artery bypass surgery Eur. J. Cardiothorac. Surg., January 1, 2009; 35(1): 48 - 53. [Abstract] [Full Text] [PDF]

				H. Aslan, O. Turgut, K. Yalta, M. B. Yilmaz, R. Ozdemir, N. Ermis, A. T. Sezgin, E. Yetkin, I. Tandogan, and A. Yilmaz Coronary Collateral Circulation: Any Effect on P-Wave Dispersion? Angiology, August 1, 2008; 59(4): 448 - 453. [Abstract] [PDF]

				J. C. Velasquez-Castano and W. R. Taylor Angiotensin II and New Vessel Formation: Aiming for the Right Oxidative Window Arterioscler Thromb Vasc Biol, January 1, 2008; 28(1): 4 - 5. [Full Text] [PDF]

				P. Meier, S. Gloekler, R. Zbinden, S. Beckh, S. F. de Marchi, S. Zbinden, K. Wustmann, M. Billinger, R. Vogel, S. Cook, et al. Beneficial Effect of Recruitable Collaterals: A 10-Year Follow-Up Study in Patients With Stable Coronary Artery Disease Undergoing Quantitative Collateral Measurements Circulation, August 28, 2007; 116(9): 975 - 983. [Abstract] [Full Text] [PDF]

				L. O. Jensen, P. Thayssen, J. F. Lassen, H. S. Hansen, H. Kelbaek, A. Junker, K. E. Pedersen, K. N. Hansen, L. R. Krusell, H. E. Botker, et al. Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention Eur. Heart J., August 1, 2007; 28(15): 1820 - 1826. [Abstract] [Full Text] [PDF]

				M. Sezer, H. Oflaz, T. Goren, I. Okcular, B. Umman, Y. Nisanci, A. K. Bilge, Y. Sanli, M. Meric, and S. Umman Intracoronary Streptokinase after Primary Percutaneous Coronary Intervention N. Engl. J. Med., May 3, 2007; 356(18): 1823 - 1834. [Abstract] [Full Text] [PDF]

				C. Berry, K. P. Balachandran, P. L. L'Allier, J. Lesperance, R. Bonan, and K. G. Oldroyd Importance of collateral circulation in coronary heart disease Eur. Heart J., February 1, 2007; 28(3): 278 - 291. [Abstract] [Full Text] [PDF]

				A. Buehler, M. A.M.J. van Zandvoort, B. J. Stelt, T. M. Hackeng, B. H.G.J. Schrans-Stassen, A. Bennaghmouch, L. Hofstra, J. P.M. Cleutjens, A. Duijvestijn, M. B. Smeets, et al. cNGR: A Novel Homing Sequence for CD13/APN Targeted Molecular Imaging of Murine Cardiac Angiogenesis In Vivo Arterioscler Thromb Vasc Biol, December 1, 2006; 26(12): 2681 - 2687. [Abstract] [Full Text] [PDF]

				M. J. Kern Walking With Sir William: Reflections on Collateral Steal, Recruitment, and Ischemic Protection J. Am. Coll. Cardiol., July 4, 2006; 48(1): 66 - 69. [Full Text] [PDF]

				D Perera, P Postema, R Rashid, S Patel, L Blows, M Marber, and S Redwood Does a well developed collateral circulation predispose to restenosis after percutaneous coronary intervention? An intravascular ultrasound study Heart, June 1, 2006; 92(6): 763 - 767. [Abstract] [Full Text] [PDF]

				R Zbinden, S Zbinden, M Billinger, S Windecker, B Meier, and C Seiler Influence of diabetes mellitus on coronary collateral flow: an answer to an old controversy Heart, October 1, 2005; 91(10): 1289 - 1293. [Abstract] [Full Text] [PDF]

				S. F. de Marchi, P. Oswald, S. Windecker, B. Meier, and C. Seiler Reciprocal relationship between left ventricular filling pressure and the recruitable human coronary collateral circulation Eur. Heart J., March 2, 2005; 26(6): 558 - 566. [Abstract] [Full Text] [PDF]

				J. K. Olijhoek, J. Koerselman, P. P.Th. de Jaegere, M. C. Verhaar, D. E. Grobbee, Y. van der Graaf, F. L.J. Visseren, and for the SMART Study Group Presence of the Metabolic Syndrome Does Not Impair Coronary Collateral Vessel Formation in Patients With Documented Coronary Artery Disease Diabetes Care, March 1, 2005; 28(3): 683 - 689. [Abstract] [Full Text] [PDF]

				K P Balachandran, C Berry, J Norrie, B D Vallance, M Malekianpour, T J Gilbert, A C H Pell, and K G Oldroyd Relation between coronary pressure derived collateral flow, myocardial perfusion grade, and outcome in left ventricular function after rescue percutaneous coronary intervention Heart, December 1, 2004; 90(12): 1450 - 1454. [Abstract] [Full Text] [PDF]

				D. Perera, S. Biggart, P. Postema, S. Patel, P. Lambiase, M. Marber, and S. Redwood Right atrial pressure: Can it be ignored when calculating fractional flow reserve and collateral flow index? J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2089 - 2091. [Full Text] [PDF]

				H. M. Nathoe, E. Buskens, E. W.L. Jansen, W. J.L. Suyker, P. R. Stella, J. R. Lahpor, W.-J. van Boven, D. van Dijk, J. C. Diephuis, C. Borst, et al. Role of Coronary Collaterals in Off-Pump and On-Pump Coronary Bypass Surgery Circulation, September 28, 2004; 110(13): 1738 - 1742. [Abstract] [Full Text] [PDF]

				M.H. Tayebjee, G.Y.H. Lip, and R.J. MacFadyen Collateralization and the response to obstruction of epicardial coronary arteries QJM, May 1, 2004; 97(5): 259 - 272. [Abstract] [Full Text] [PDF]

				N. van Royen, M. Voskuil, I. Hoefer, M. Jost, S. de Graaf, F. Hedwig, J.-P. Andert, T.A.M. Wormhoudt, J. Hua, S. Hartmann, et al. CD44 Regulates Arteriogenesis in Mice and Is Differentially Expressed in Patients With Poor and Good Collateralization Circulation, April 6, 2004; 109(13): 1647 - 1652. [Abstract] [Full Text] [PDF]

				S Zbinden, N Brunner, K Wustmann, M Billinger, B Meier, and C Seiler Effect of statin treatment on coronary collateral flow in patients with coronary artery disease Heart, April 1, 2004; 90(4): 448 - 449. [Full Text] [PDF]

				J A de Lemos and J J Warner New tools for assessing microvascular obstruction in patients with ST elevation myocardial infarction Heart, February 1, 2004; 90(2): 119 - 120. [Full Text] [PDF]

				C. Seiler The human coronary collateral circulation Heart, November 1, 2003; 89(11): 1352 - 1357. [Full Text] [PDF]