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Predictors and Prognostic Implications of Well-Matured Coronary Collateral Circulation in Patients with a Chronic

Usaid K Allahwala^1,2, Katharine Kott^1,2, Adam Bland¹

¹Department of Cardiology, Royal North Shore Hospital.

International Heart Journal

|March 17, 2020

Insights

Well-matured coronary collaterals in chronic total occlusion (CTO) patients are linked to female sex, lower chronic kidney disease (CKD) rates, and higher procedural success. However, collateral maturation does not impact long-term mortality.

Area of Science:

Cardiovascular Medicine
Interventional Cardiology
Vascular Biology

Background:

Coronary artery chronic total occlusion (CTO) presents challenges in percutaneous coronary intervention (PCI).
The predictors and prognostic significance of well-developed collateral circulation in CTO patients remain incompletely understood.
Collateral vessels are crucial for myocardial perfusion in occluded arteries.

Purpose of the Study:

To identify factors predicting collateral maturation in CTO patients undergoing PCI.
To evaluate the impact of collateral maturation on procedural success and long-term prognosis.
To understand the relationship between collateral development and patient characteristics.

Main Methods:

Retrospective analysis of 212 CTO PCI patients (April 2010 - July 2019).
Exclusion of patients with prior coronary artery bypass grafting (CABG) to the CTO or only bridging collaterals.
Assessment of collateral maturation using Rentrop grading; analysis of demographic, biochemical, and anatomical factors, and procedural/long-term outcomes.

Main Results:

Well-matured collaterals (Rentrop grade 3) were associated with female sex, lower rates of chronic kidney disease (CKD), and prior CABG.
Patients with better collateralization had a lower neutrophil-to-leukocyte ratio (NLR).
Procedural success rates were significantly higher in patients with well-matured collaterals (90.5%) compared to poorly matured ones (34.6%).
Collateral maturation was not significantly associated with longer-term mortality.

Conclusions:

Improved collateral maturation in CTO is associated with female sex, lower CKD and CABG rates, and reduced NLR.
Enhanced collateralization significantly increases the likelihood of successful CTO PCI.
While improving procedural success, collateral maturation does not appear to influence long-term patient prognosis.

Read full analysis

Abstract:

The predictors and prognostic implications of well-matured collaterals in those with a chronic total occlusion (CTO) are unknown. We sought to identify the determinants of collateral maturation and to determine its effects on procedural outcomes and prognosis.Patients presenting for CTO percutaneous coronary intervention (PCI) between April 2010 and July 2019 were included. Patients with a previous coronary artery bypass (CABG) to the CTO and those with only bridging collaterals were excluded. The degree of collateral maturation was determined by the Rentrop grading classification. Demographic, biochemical, and anatomical factors and procedural and longer-term outcomes were identified.A total of 212 patients were included in the study. Patients with well-matured collaterals were more likely to be females (29.7% versus 15.2% versus 0%, P < 0.005 for Rentrop grade 3, 2, and 0 or 1, respectively), less likely to have chronic kidney disease (CKD) (8.8% versus 4.5% versus 19.2%, P < 0.05) and less likely to have had a prior CABG (15.6% versus 18.7% versus 19.2%). Patients with well-matured collaterals had lower neutrophil-to-leukocyte ratio (NLR) (2.8 versus 4.0 versus 5.7, P < 0.0001). Patients with well-matured collaterals were more likely to have procedural success (90.5% versus 62.5% versus 34.6%, P < 0.0001). The degree of collateral maturation was not associated with longer-term mortality.Improved collateral maturation was associated with female sex and lower rates of CKD and CABG and a lower NLR. Those with well-matured collaterals had a significantly higher rate of procedural success but not improved prognosis.

Keywords:

Coronary artery disease (CAD)Percutaneous coronary intervention (PCI)Rentrop

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