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Published on: January 28, 2020
Clinical parameters associated with collateral development in patients with chronic total coronary occlusion
N W van der Hoeven1, P F Teunissen, G S Werner
1Department of Cardiology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands. nw.vanderhoeven@gmail.com
Insights
Well-developed collaterals in obstructive coronary artery disease (CAD) are linked to survival. This study found that high serum leucocytes and diastolic blood pressure are associated with poorly developed collaterals, while beta blockers may promote better collateralization.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Research
Background:
- Well-developed collateral circulation is crucial for survival in patients with obstructive coronary artery disease (CAD).
- Understanding the factors influencing arteriogenesis, the development of new blood vessels, is vital for improving outcomes in CAD patients.
- Previous studies explored various patient groups, but this research focuses on a unique cohort with chronic total occlusions (CTO).
Purpose of the Study:
- To identify clinical and laboratory variables associated with arteriogenesis in patients with obstructive coronary artery disease.
- To investigate factors influencing the collateral flow index (CFI) in a unique cohort of CTO patients.
- To explore the relationship between specific clinical variables and the development of coronary collaterals.
Main Methods:
- A pooled analysis of data from 295 chronic total occlusion (CTO) patients across three European centers.
- Collateral flow index (CFI) was accurately determined using intracoronary pressure measurements, a more precise method than traditional angiography.
- Multivariate analysis was employed to identify significant clinical and laboratory predictors of CFI.
Main Results:
- The mean CFI in the study cohort was 0.39 ± 0.14.
- Multivariate analysis revealed positive associations between beta blockers, hypertension, and angina pectoris duration with CFI.
- Conversely, high serum leucocytes, prior myocardial infarction, and high diastolic blood pressure were negatively associated with CFI.
Conclusions:
- High serum leucocytes and high diastolic blood pressure are associated with poorly developed collateral circulation in CTO patients.
- The use of beta blockers showed a positive association with well-developed collaterals, suggesting a potential role in arteriogenesis.
- These findings offer new insights into the factors influencing collateral development and the potential mechanisms of beta blockers in CAD management.
Objective:
Well-developed collaterals provide survival benefit in patients with obstructive coronary artery disease (CAD). Therefore, in this study we sought to determine which clinical variables are associated with arteriogenesis.
Design:
Clinical and laboratory variables were collected before percutaneous coronary intervention. Multivariate analysis was performed to determine which variables are associated with the collateral flow index (CFI).
Patients:
Data from 295 chronic total occlusion (CTO) patients (Bern, Switzerland, Amsterdam, the Netherlands and Jena, Germany) were pooled. In earlier studies, patients had varying degrees of stenosis. Therefore, different stages of development of the collaterals were used. In our study, a unique group of patients with CTO was analysed.
Interventions:
Instead of angiography used earlier, we used a more accurate method to determine CFI using intracoronary pressure measurements. CFI was calculated from the occlusive pressure distal of the coronary lesion, the aortic pressure and central venous pressure.
Results:
The mean CFI was 0.39 ± 0.14. After multivariate analysis, β blockers, hypertension and angina pectoris duration were positively associated with CFI (B: correlation coefficient β=0.07, SE=0.03, p=0.02, B=0.040, SE=0.02, p=0.042 and B=0.001, SE=0.000, p=0.02). Furthermore also after multivariate analysis, high serum leucocytes, prior myocardial infarction and high diastolic blood pressure were negatively associated with CFI (B=-0.01, SE=0.005, p=0.03, B=-0.04, SE=0.02, p=0.03 and B=-0.002, SE=0.001, p=0.011).
Conclusions:
In this unique cohort, high serum leucocytes and high diastolic blood pressure are associated with poorly developed collaterals. Interestingly, the use of β blockers is associated with well-developed collaterals, shedding new light on the potential action mode of this drug in patients with CAD.
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