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The prognostic value of collateral circulation in coronary chronic total occlusion underwent percutaneous coronary
Xiao-Ying Hu1, Wei-Xian Yang1,2, Chang-Dong Guan3
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Well-developed coronary collateral circulation (CC), assessed by the Werner grading system, is linked to better long-term survival after chronic total occlusion (CTO) percutaneous coronary intervention (PCI). The Werner system offers superior prognostic value compared to the Rentrop system.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Prognostic significance of coronary collateral circulation (CC) in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains unclear.
- Evaluating CC grading systems is crucial for predicting long-term outcomes in CTO PCI patients.
Purpose of the Study:
- To assess the prognostic value of Werner and Rentrop CC grading systems.
- To determine the association between CC grading and long-term outcomes in CTO PCI patients.
Main Methods:
- 2452 patients with single-vessel CTO undergoing PCI were enrolled (Jan 2010-Dec 2013).
- Patients were classified using Werner (grade 2 vs. 0-1) and Rentrop (grade 3 vs. 0-2) CC grading systems.
- Primary endpoint was 5-year cardiac death.
Main Results:
- Well-developed collaterals (Werner grade 2) were found in 28.0% of patients.
- Werner grade 2 CC was associated with a lower 5-year cardiac death rate (1.6% vs. 3.3%, P=0.02).
- Suboptimal PCI success correlated with higher cardiac death rates compared to optimal success.
Conclusions:
- Well-developed collaterals, by Werner's definition, predict lower 5-year cardiac death post-CTO PCI.
- The Werner CC grading system demonstrates greater prognostic value than the Rentrop system in this patient cohort.
Background:
The prognostic value of coronary collateral circulation (CC) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is underdetermined. The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI.
Methods:
We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December 2013. All patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner's CC (grade 2 vs. grade 0-1) or Rentrop (grade 3 vs. grade 0-2) grading system. The primary endpoint was 5-year cardiac death.
Results:
Of 2452 enrolled patients, the overall technical success rate was 74.1%. Well-developed collaterals were present in 686 patients (28.0%) defined by Werner's CC grade 2, and in 1145 patients (46.7%) by Rentrop grade 3. According to Werner's CC grading system, patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poor-developed collaterals (1.6% vs. 3.3%, P = 0.02), those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization (4.7% vs. 0.8%, P = 0.01) and failure patients (4.7% vs. 1.6%, P = 0.12). However, the similar effect was not shown in Rentrop grading system.
Conclusions:
In patients with the single-vessel CTO underwent PCI, well-developed collaterals by Werner's CC definition were associated with lower rate of 5-year cardiac death. Werner's CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.
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