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Collateral arteries in the presence of obstructive coronary disease
S Ramamurthy1, S Sharma, R K Kumar
1Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Insights
Coronary artery collaterals may reduce rest angina in patients with obstructive coronary artery disease. Good collateralization significantly lowers the incidence of rest angina compared to poor collateralization.
Area of Science:
- Cardiology
- Vascular Biology
- Interventional Cardiology
Background:
- The clinical significance of coronary collaterals in obstructive coronary artery disease (CAD) remains unclear.
- Understanding collateral function is crucial for managing patients with severe CAD.
Purpose of the Study:
- To investigate the influence of coronary collaterals on clinical parameters in patients with severe obstructive coronary artery disease.
Main Methods:
- Retrospective analysis of 100 patients with >=90% stenosis in a major coronary artery.
- Coronary collaterals were graded using Nitzberg's classification (0-4).
- Clinical and angiographic features were correlated with collateral status.
Main Results:
- Patients with collaterals (n=70) had a significantly lower prevalence of rest angina (14%) compared to those without (n=30, 47%; p=0.002).
- Good collateralization (Nitzberg grades 3-4) was associated with a lower incidence of rest angina (13%) versus poor collateralization (grades 0-2, 35%; p=0.02).
- No significant differences in demographics, risk factors, or lesion characteristics were observed between groups.
Conclusions:
- Coronary artery collaterals appear to play a protective role against rest angina in obstructive CAD.
- Effective collateralization may mitigate anginal symptoms in severe coronary artery disease.
Background:
The clinical importance of coronary collaterals in the presence of obstructive coronary artery disease is not clearly defined.
Methods:
We retrospectively analysed the clinical and angiographic features of 100 patients with > or = 90% luminal diameter stenosis involving at least one major coronary artery. Coronary collaterals were graded 0 to 4 (Nitzberg's classification) and studied to determine their influence on clinical parameters.
Results:
Thirty patients had no collaterals (group I) and 70 showed collaterals (group II). There were no significant differences between groups I and II in age and sex distribution, prevalence of risk factors of coronary artery disease (hypertension, diabetes, smoking, hypercholesterolaemia), duration of symptoms of coronary artery disease and prior myocardial infarction. Groups I and II had similar types (left anterior descending 73% v. 71%; left circumflex 50% v. 50% and right coronary 37% v. 56%) and numbers of arteries involved (one 47% v. 41%; two 47% v. 40%; three 7% v. 19%). Group II had a significantly lower prevalence of rest angina (14% v. 47%, p = 0.002). This difference was also evident when the patients were re-classified according to the extent of flow through the collaterals. Those with good collateralization (Nitzberg grades 3 and 4) had a lower prevalence of rest angina (13%) compared to those with poor collateralization (Nitzberg grades 0 to 2; 35%, p = 0.02).
Conclusion:
Coronary artery collaterals may reduce the incidence of rest angina in patients with obstructive coronary artery disease.