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(Circulation. 2007;116:975-983.)
© 2007 American Heart Association, Inc.

Coronary Heart Disease

Beneficial Effect of Recruitable Collaterals

A 10-Year Follow-Up Study in Patients With Stable Coronary Artery Disease Undergoing Quantitative Collateral Measurements

Pascal Meier, MD^*; Steffen Gloekler, MD^*; Rainer Zbinden, MD^*; Sarah Beckh, BS; Stefano F. de Marchi, MD; Stephan Zbinden, MD; Kerstin Wustmann, MD; Michael Billinger, MD; Rolf Vogel, MD, PhD; Stéphane Cook, MD; Peter Wenaweser, MD; Mario Togni, MD; Stephan Windecker, MD; Bernhard Meier, MD; Christian Seiler, MD

From the Department of Cardiology, University Hospital, Bern, Switzerland.

Correspondence to Christian Seiler, MD, FACC, FESC, Professor of Medicine and Co-Chairman of Cardiology, University Hospital, CH-3010 Bern, Switzerland. E-mail christian.seiler{at}insel.ch

Received March 19, 2007; accepted June 25, 2007.

Background— The prognostic relevance of the collateral circulation is still controversial. The goal of this study was to assess the impact on survival of quantitatively obtained, recruitable coronary collateral flow in patients with stable coronary artery disease during 10 years of follow-up.

Methods and Results— Eight-hundred forty-five individuals (age, 62±11 years), 106 patients without coronary artery disease and 739 patients with chronic stable coronary artery disease, underwent a total of 1053 quantitative, coronary pressure–derived collateral measurements between March 1996 and April 2006. All patients were prospectively included in a collateral flow index (CFI) database containing information on recruitable collateral flow parameters obtained during a 1-minute coronary balloon occlusion. CFI was calculated as follows: equation

where P_occl is mean coronary occlusive pressure, P_ao is mean aortic pressure, and CVP is central venous pressure. Patients were divided into groups with poorly developed (CFI <0.25) or well-grown collateral vessels (CFI 0.25). Follow-up information on the occurrence of all-cause mortality and major adverse cardiac events after study inclusion was collected. Cumulative 10-year survival rates in relation to all-cause deaths and cardiac deaths were 71% and 88%, respectively, in patients with low CFI and 89% and 97% in the group with high CFI (P=0.0395, P=0.0109). Through the use of Cox proportional hazards analysis, the following variables independently predicted elevated cardiac mortality: age, low CFI (as a continuous variable), and current smoking.

Conclusions— A well-functioning coronary collateral circulation saves lives in patients with chronic stable coronary artery disease. Depending on the exact amount of collateral flow recruitable during a brief coronary occlusion, long-term cardiac mortality is reduced to one fourth compared with the situation without collateral supply.

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CLINICAL PERSPECTIVE

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