University of Alberta, Edmonton, Alberta, Canada.
Can J Cardiol. 2011 Sep-Oct;27(5):581-8. doi: 10.1016/j.cjca.2011.02.011. Epub 2011 Jul 13.
The clinical correlates of coronary collaterals and the effects of coronary collaterals on prognosis are incompletely understood.
We performed a study of 55,751 patients undergoing coronary angiography to evaluate the correlates of angiographically apparent coronary collaterals, and to evaluate their association with survival.
The characteristic most strongly associated with the presence of collaterals was a coronary occlusion (odds ratio [OR], 28.9; 95% confidence interval [CI], 27.1-30.6). Collaterals were associated with improved adjusted survival overall (hazard ratio [HR] 0.89; 95% CI, 0.85-0.95), and in both acute coronary syndrome (ACS) (HR 0.90; 95% CI, 0.84-0.96) and non-ACS (HR 0.84; 95% CI, 0.77-0.92) patients. Collaterals were associated with improved survival in those receiving angioplasty (HR 0.78; 95% CI, 0.71-0.85) and those with low risk anatomy treated medically (HR 0.84; 95% CI, 0.72-0.98), but not for those treated with coronary bypass graft surgery or those with high-risk anatomy treated without revascularization.
The major correlate of coronary collaterals is the presence/extent of obstructive coronary artery disease. Collaterals are associated with better survival overall and in both ACS and non-ACS presentations, but not for those treated with coronary artery bypass graft (CABG) or those with high-risk anatomy who are not revascularized.
冠状动脉侧支循环的临床相关性及其对预后的影响尚不完全清楚。
我们对 55751 例行冠状动脉造影的患者进行了一项研究，以评估冠状动脉侧支循环的影像学表现，并评估其与生存率的关系。
与侧支循环存在最密切相关的特征是冠状动脉闭塞（比值比 [OR]，28.9；95%置信区间 [CI]，27.1-30.6）。侧支循环与总体校正后生存率的提高有关（风险比 [HR] 0.89；95%CI，0.85-0.95），无论是在急性冠状动脉综合征（ACS）（HR 0.90；95%CI，0.84-0.96）还是非 ACS 患者（HR 0.84；95%CI，0.77-0.92）。在接受血管成形术治疗的患者（HR 0.78；95%CI，0.71-0.85）和接受低风险解剖结构药物治疗的患者（HR 0.84；95%CI，0.72-0.98）中，侧支循环与生存改善相关，但在接受冠状动脉旁路移植术（CABG）治疗的患者或未进行血运重建的高风险解剖结构患者中则无此关联。
冠状动脉侧支循环的主要相关因素是阻塞性冠状动脉疾病的存在/程度。侧支循环与整体生存率以及 ACS 和非 ACS 患者的生存率提高相关，但与 CABG 治疗的患者或未进行血运重建的高风险解剖结构患者的生存率提高无关。
