Department of Cardiology, Shanghai Ruijin Hospital, Shanghai 200025, China.
J Zhejiang Univ Sci B. 2013 Aug;14(8):705-12. doi: 10.1631/jzus.BQICC704.
Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion.
Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system.
Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high collateralization (for all comparisons, P<0.05). In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein (hsCRP) compared with those with high collateralization. Multivariate analysis revealed that age of ≥65 years, female gender, diabetes, no history of hypertension, dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were independently associated with low coronary collateralization.
Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.
在存在严重冠状动脉疾病的情况下，冠状侧支循环是心肌的另一种血液供应源。我们旨在确定哪些临床和血管造影变量与稳定型心绞痛和慢性完全闭塞的患者的侧支发育有关。
从 478 例稳定型心绞痛和慢性完全闭塞的患者中收集人口统计学变量、生化测量值和血管造影结果。根据 Rentrop 评分系统，将从对侧血管供应完全闭塞远端的侧支的存在和程度从 0 到 3 进行分级。
分别在 186 例和 292 例患者中检测到低（Rentrop 评分 0 或 1）和高（Rentrop 评分 2 或 3）冠状侧支循环。尽管年龄、吸烟和药物治疗相似，但低侧支循环患者中女性比例更高，高血压发生率更低，2 型糖尿病和血脂异常发生率更高，与高侧支循环患者相比（所有比较，P<0.05）。此外，与高侧支循环患者相比，低侧支循环患者表现出更多的单支血管疾病、更少的右冠状动脉闭塞、更受损的肾功能和更高的血清高敏 C 反应蛋白（hsCRP）水平。多变量分析显示，年龄≥65 岁、女性、糖尿病、无高血压病史、血脂异常、中重度肾功能不全、单支血管疾病和升高的 hsCRP 水平与低冠状侧支循环独立相关。
近 40%的慢性完全闭塞稳定型心绞痛患者的冠状侧支循环减少，这与临床和血管造影因素有关。冠状侧支循环对血运重建后结局的影响需要进一步研究。
