Abstract 18332: Clinical Parameters Associated with the Development of the Coronary Collateral Circulation in Patients with a Chronic Total Occlusion
A well-developed collateral circulation provides a survival benefit in patients with obstructive coronary artery disease. Studies aiming to detect clinical parameters associated with collateral circulation show controversial results and have only been assessed in studies using angiographic assessment of the collateral circulation and mainly in patients with non-occlusive lesions. Here we assess the correlation of clinical parameters with intracoronary derived collateral flow index (CFI) a unique group of patients with a chronic total occlusion (CTO) in which was measured directly upon opening of the CTO. Data from 295 patients (Bern, Switzerland, Amsterdam, the Netherlands and Jena, Germany) were pooled. Clinical parameters and lab values were collected before the procedure. CFI was calculated from the occlusive pressure distal from the coronary lesion (Pd), the aortic pressure (Pao) and central venous pressure (CVP). Multivariate analysis was performed to assess the correlation between collateral formation and clinical parameters. The mean CFI was 0.39 ± 0.14. After multivariate analysis, β-blockers, hypertension and duration of AP were positively associated with a well-developed collateral circulation (respectively B=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, high serum leukocytes, prior MI and high diastolic blood pressure were negatively associated with a well-developed collateral circulation (respectively 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). In a unique cohort of CTO patients we show that high serum leukocytes and high diastolic blood pressure are associated with a poorly developed collateral circulation. Interestingly, the use of β-blockers is positively associated with a well developed collateral circulation, shedding new light on the potential mode of action of this drug in patients with angina pectoris.
- © 2012 by American Heart Association, Inc.