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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

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