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

Meier, Pascal; Gloekler, Steffen; Zbinden, Rainer; Beckh, Sarah; de Marchi, Stefano F.; Zbinden, Stephan; Wustmann, Kerstin; Billinger, Michael; Vogel, Rolf; Cook, Stéphane; Wenaweser, Peter; Togni, Mario; Windecker, Stephan; Meier, Bernhard; Seiler, Christian (2007). Beneficial effect of recruitable collaterals: a 10-year follow-up study in patients with stable coronary artery disease undergoing quantitative collateral measurements. Circulation, 116(9), pp. 975-983. Baltimore, Md.: Lippincott Williams & Wilkins 10.1161/CIRCULATIONAHA.107.703959

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BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie

UniBE Contributor:

Glökler, Steffen; Zbinden, Rainer; de Marchi, Stefano; Zbinden, Stephan; Wustmann, Kerstin Brigitte; Billinger, Michael; Vogel, Rolf; Wenaweser, Peter Martin; Windecker, Stephan; Meier, Bernhard and Seiler, Christian

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0009-7322

ISBN:

17679611

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:54

Last Modified:

09 Jul 2014 14:18

Publisher DOI:

10.1161/CIRCULATIONAHA.107.703959

PubMed ID:

17679611

Web of Science ID:

000249031100003

URI:

https://boris.unibe.ch/id/eprint/23217 (FactScience: 40614)

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