Perera D, Postema P, Rashid R, Patel S, Blows L, Marber M, Redwood S. Does a well developed collateral circulation predispose to restenosis after percutaneous coronary intervention? An intravascular ultrasound study.
Heart 2005;
92:763-7. [PMID:
16216859 PMCID:
PMC1860667 DOI:
10.1136/hrt.2005.067322]
[Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE
To evaluate whether a well developed collateral circulation predisposes to restenosis after percutaneous coronary intervention (PCI).
DESIGN
Prospective observational study.
PATIENTS AND SETTING
58 patients undergoing elective single vessel PCI in a tertiary referral interventional cardiac unit in the UK.
METHODS
Collateral flow index (CFI) was calculated as (Pw-Pv)/(Pa-Pv), where Pa, Pw, and Pv are aortic, coronary wedge, and right atrial pressures during maximum hyperaemia. Collateral supply was considered poor (CFI < 0.25) or good (CFI > or = 0.25).
MAIN OUTCOME MEASURES
In-stent restenosis six months after PCI, classified as neointimal volume > or = 25% stent volume on intravascular ultrasound (IVUS), or minimum lumen area < or = 50% stent area on IVUS, or minimum lumen diameter < or = 50% reference vessel diameter on quantitative coronary angiography.
RESULTS
Patients with good collaterals had more severe coronary stenoses at baseline (90 (11)% v 75 (16)%, p < 0.001). Restenosis rates were similar in poor and good collateral groups (35% v 43%, p = 0.76 for diameter restenosis, 27% v 45%, p = 0.34 for area restenosis, and 23% v 24%, p = 0.84 for volumetric restenosis). CFI was not correlated with diameter, area, or volumetric restenosis (r2 < 0.1 for each). By multivariate analysis, stent diameter, stent length, > 10% residual stenosis, and smoking history were predictive of restenosis.
CONCLUSION
A well developed collateral circulation does not predict an increased risk of restenosis after PCI.
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