Physiologically assessed coronary collateral flow and adverse cardiac ischemic events: a follow-up study in 403 patients with coronary artery disease
Michael Billinger, MD*,
Patrik Kloos, BS*,
Franz R. Eberli, MD*,
Stephan Windecker, MD*,
Bernhard Meier, MD, FACC* and
Christian Seiler, MD, FACC*,*
* Division of Cardiology, Swiss Cardiovascular Center Bern, Bern, Switzerland
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Figure 1 Simultaneous determination of intracoronary flow velocity (cm/s) and pressure (mm Hg) measurements. The flow velocity trend over 90 s is shown during vessel occlusion (Voccl) and during vessel patency (Vø-occl) in the left upper panel of the figure. In the upper part, the instantaneous flow velocity signal (cm/s) during vessel occlusion is represented. On the right, simultaneous aortic (Pao) and distal occlusive (Poccl) pressure is shown. The pressure-derived collateral flow index (CFIP) was calculated as follows: (Poccl – 5)/(Pao – 5). Doppler-derived CFIV: Voccl/Vø-occl. CFIv = velocity-derived index of collateral flow.
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Figure 2 Individual collateral flow index values (vertical axis) divided into five categories (horizontal axis): patients without any cardiac ischemic event during the follow-up period (left side); patients with major adverse cardiac ischemic events (MACE); patients with unstable angina pectoris (UAP); patients with myocardial infarction (MI); patients who died (Death).
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Figure 3 Cumulative event rate analysis (vertical axis): time to the occurrence of a major adverse cardiac ischemic event (death, myocardial infarction, or unstable angina pectoris) during follow-up. Only three patients (2%) with good collaterals, but 24 patients (9%) with poor collaterals, suffered a major adverse cardiac ischemic event during the first year after successful percutaneous transluminal coronary angioplasty. CFI = collateral flow index.
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Figure 4 Frequency of cardiac ischemic events (vertical axis): the overall event rate was not different between the two groups. Only 2.2% of the patients with high collateral flow suffered a major adverse cardiac ischemic event compared with 9.0% of the patients with poor collaterals (p = 0.01). However, the incidence of angina pectoris was significantly higher in patients with abundant compared with patients with scarce collaterals (21% vs. 12%; p = 0.01). CFI = collateral flow index.
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