Coronary collaterals remain recruitable after percutaneous intervention
Divaka Perera1, Gajen S Kanaganayagam, Mrinal Saha
1Cardiovascular Division, Rayne Institute, St Thomas' Hospital Campus, King's College, London, UK.
Insights
Coronary collateral flow remains stable for 24 hours post-PCI but declines significantly by 6 months. Circulating stem cells correlate with collateral function after intervention.
Area of Science:
- Cardiovascular Research
- Interventional Cardiology
- Vascular Biology
Background:
- Percutaneous coronary intervention (PCI) can lead to rapid loss of collateral support, increasing myocardial infarction risk.
- Well-developed coronary collaterals exist even without ischemic stimuli, indicating inherent plasticity.
- Understanding collateral supply dynamics post-PCI is crucial for managing myocardial perfusion.
Purpose of the Study:
- To assess the plasticity and determinants of coronary collateral supply after PCI.
- To evaluate changes in collateral flow index (CFI) over time post-PCI.
- To identify factors influencing collateral function, including lesion characteristics and circulating hemopoietic cells.
Main Methods:
- Calculated collateral flow index (CFI) using pressure measurements (aortic, central venous, coronary wedge).
- Measured CFI at baseline, 5 minutes, 24 hours, and 6 months after successful PCI in 60 patients.
- Assessed relationships between CFI, coronary lesion severity, and circulating CD133+ and CD34+ cells.
Main Results:
- CFI remained unchanged at 5 minutes and 24 hours post-PCI.
- CFI significantly decreased by 6 months, representing 63% of baseline values (P<0.001).
- Baseline CFI correlated with lesion severity, but this association was lost at 6 months. Circulating CD133+ and CD34+ cells correlated with 6-month CFI.
Conclusions:
- Coronary collateral flow is maintained for at least 24 hours after successful PCI.
- Functional collateral support diminishes significantly by 6 months post-PCI but does not completely regress.
- Circulating hemopoietic stem cells may play a role in maintaining collateral function long-term after PCI.
Background:
Rapid loss of collateral support has been reported after percutaneous coronary intervention (PCI), leaving the myocardium susceptible to subsequent infarction. However, well-developed collaterals have been found in normal hearts, suggesting that collaterals exist even in the absence of an ischemic stimulus. We assessed the plasticity and determinants of collateral supply after PCI.
Methods And Results:
Collateral flow index (CFI) was calculated in 60 patients as (P(w)-P(v))/(P(a)-P(v)) by measurement of aortic (P(a)), central venous (P(v)), and coronary wedge (P(w)) pressures. CFI was reassessed during transient balloon occlusion 5 minutes and 24 hours after PCI in the first 29 patients and at 6 months in the subsequent 25 patients. We also evaluated the relationship between collateral supply, lesion characteristics, and circulating hemopoietic cells numbers before and after successful PCI. CFI at baseline was 0.23+/-0.10, with no change 5 minutes and 1 day later (0.21+/-0.12, P=0.62; and 0.22+/-0.11, P=0.96, respectively). At 6 months, CFI was 0.14+/-0.07 or 63+/-27% of the baseline value (P<0.001). CFI was proportional to severity of the coronary lesion at baseline (r=0.63, P<0.0001) but not 6 months after PCI (r=-0.04, P=0.87). The number of circulating CD133+ and CD34+ cells was associated with CFI 6 months after PCI (CD133, r=0.59, P=0.035; CD34, r=0.63, P=0.037).
Conclusions:
Coronary collateral flow remains undiminished for at least 24 hours after successful PCI. Functional collateral support subsequently declines but does not regress completely.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:28Acute Coronary Syndrome IV: Interprofessional Care