Billinger Michael, Kloos Patrik, Eberli Franz R, Windecker Stephan, Meier Bernhard, Seiler Christian
Division of Cardiology, Swiss Cardiovascular Center Bern, CH-3010 Bern, Switzerland.
J Am Coll Cardiol. 2002 Nov 6;40(9):1545-50. doi: 10.1016/s0735-1097(02)02378-1.
We sought to evaluate whether coronary collateral flow is clinically relevant for future cardiac ischemic events.
The link between good collateral supply related to less myocardial damage and fewer cardiac events has not been established prospectively beyond doubt.
In 403 patients with stable angina pectoris undergoing percutaneous transluminal coronary angioplasty (PTCA) and quantitative collateral assessment, the occurrence of major adverse cardiac events ([MACE] cardiac death, myocardial infarction, unstable angina pectoris) and stable angina pectoris was monitored during follow-up. Collateral flow index (CFI) was determined using intracoronary pressure or Doppler guidewires. Mean aortic ([P(ao)] mm Hg) and distal coronary artery occlusive pressure ([P(occl)] mm Hg) during balloon angioplasty (PTCA), or distal coronary flow velocity time integral during ([V(occl)] cm) and after ([V(ø-occl)] cm) PTCA were measured continuously. Pressure-derived CFI was calculated as follows: (P(occl) - 5)/(P(ao) - 5). Doppler-derived CFI: V(occl)/V(ø-occl). Patients were subdivided into a group with well (CFI > or = 0.25) and poorly developed collaterals (CFI < 0.25).
Average follow-up was 94 +/- 56 (15 to 202) weeks. There were 134 patients with CFI >or =0.25 (61 +/- 11 years) and 269 with CFI <0.25 (61 +/- 10 years). The overall cardiac ischemic event rate (MACE and stable angina pectoris) during follow-up was 23% in patients with CFI > or =0.25 and 20% in patients with CFI <0.25 (p = NS). However, only 2.2% of patients with good collateral flow suffered a major cardiac ischemic event, compared with 9.0% among patients with poorly developed collaterals (p = 0.01). The incidence of stable angina pectoris was significantly higher in patients with well developed collaterals than in those with poorly developed collaterals (21% vs. 12%; p = 0.01).
In this relatively large population with chronic stable coronary artery disease undergoing quantitative collateral measurement, the beneficial impact of well developed collateral vessels on the occurrence of future major cardiac ischemic events is clearly demonstrated.
我们试图评估冠状动脉侧支血流对于未来心脏缺血事件是否具有临床相关性。
良好的侧支循环供应与较少的心肌损伤及较少的心脏事件之间的联系，尚未在前瞻性研究中得到确凿证实。
对403例接受经皮冠状动脉腔内血管成形术（PTCA）并进行侧支循环定量评估的稳定型心绞痛患者，在随访期间监测主要不良心脏事件（心脏死亡、心肌梗死、不稳定型心绞痛）和稳定型心绞痛的发生情况。使用冠状动脉内压力或多普勒导丝测定侧支血流指数（CFI）。在球囊血管成形术（PTCA）期间连续测量平均主动脉压（[P(ao)] mmHg）和冠状动脉远端闭塞压（[P(occl)] mmHg），或在PTCA期间（[V(occl)] cm）和之后（[V(ø-occl)] cm）测量冠状动脉远端血流速度时间积分。压力衍生的CFI计算如下：(P(occl) - 5)/(P(ao) - 5)。多普勒衍生的CFI：V(occl)/V(ø-occl)。患者被分为侧支循环良好（CFI≥0.25）和侧支循环发育不良（CFI<0.25）两组。
平均随访时间为94±56（15至202）周。有134例CFI≥0.25的患者（61±11岁）和269例CFI<0.25的患者（61±10岁）。随访期间，CFI≥0.25的患者总体心脏缺血事件发生率（主要不良心脏事件和稳定型心绞痛）为23%，CFI<0.25的患者为20%（p=无显著性差异）。然而，侧支血流良好的患者中只有2.2%发生了主要心脏缺血事件，而侧支循环发育不良的患者中这一比例为9.0%（p=0.01）。侧支循环良好的患者中稳定型心绞痛的发生率显著高于侧支循环发育不良的患者（21%对12%；p=0.01）。
在这个接受侧支循环定量测量的相对较大的慢性稳定型冠状动脉疾病患者群体中，侧支血管发育良好对未来主要心脏缺血事件发生的有益影响得到了明确证实。
