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Is coronary revascularization necessary for patients with well-developed coronary collaterals and coronary artery disease?
International Journal of Cardiology 125 (2008) 103 www.elsevier.com/locate/ijcard
Letter to the Editor
Is coronary revascularization necessary for patients with well-developed coronary collaterals and coronary artery disease? Ersan Tatli ⁎, Mutlu Buyuklu Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey Received 20 November 2006; accepted 31 December 2006 Available online 16 April 2007
Keywords: Coronary collaterals; Coronary revascularization; Prognosis; Coronary artery disease
Coronary collaterals, or “natural bypasses,” are anastomotic connections without an intervening capillary bed between portions of the same coronary artery and between different coronary arteries [1]. They can be visualized on coronary angiography and they potentially offer an important alternative source of blood supply when the original vessel fails to provide sufficient blood [2]. Coronary collaterals may limit infarct size, preserve viability, and prevent ventricular aneurysm formation during an episode of acute coronary occlusion. In patients with stable coronary artery disease, a decrease in ischemic events and a better prognosis have been reported when collaterals are present [3]. However, the relation between well-developed coronary collaterals and prognosis had not been researched exactly. Antoniucci et al. [4] published a study on the significance of preintervention angiographic evidence of coronary collateral circulation in patients with acute MI who underwent primary angioplasty or stenting within 6 h of symptom onset. At 6 months, the mortality rate was lower in patients with coronary collateral circulation compared with patients without collaterals, without clear effects on clinical outcomes. Hendrick et al. [5] researched the relation between collaterals and cardiac death or myocardial infarction at 1 year after coronary revascularization (stent implantation and bypass grafting). They found that the presence of collaterals protected against cardiac death and myocardial infarction in patients with a low risk profile. These studies have compared mortality between the patients who were
⁎ Corresponding author. Tel.: +90 2842357641/2150, +90 5056789099 (GSM); fax: +90 2842357652. E-mail address: [email protected] (E. Tatli). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.12.075
undergone coronary revascularization. Can mortality difference be between patients with well-developed coronary collaterals who were undergone coronary revascularization or not? When the question is answered, maybe we will not need coronary revascularization in patients with well-developed coronary collaterals and coronary artery disease. We are looking forward to the comments of editors about this subject. References [1] Popma JJ, Bittl J. Coronary angiography and intravascular ultrasonography. In: Braunwald E, Zipes DP, Libby P, editors. Heart disease: a textbook of cardiovascular medicine. Philadelphia: W.B. Saunders Company; 2001. p. 387–418. [2] Sasayama S, Fujita M. Recent insights into coronary collateral circulation. Circulation 1992;85:1197–204. [3] Ishihara M, Inoue I, Kawagoe T, et al. Comparison of the cardioprotective effect of prodromal angina pectoris and collateral circulation in patients with a first anterior wall acute myocardial infarction. Am J Cardiol 2005;95:622–5. [4] Antoniucci D, Valenti R, Moschi G, et al. Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction. Am J Cardiol 2002;89:121–5. [5] Hendrick N, Jeroen K, Erik B, et al. Determinants and prognostic significance of collaterals in patients undergoing coronary revascularization. Am J Cardiol 2006;98:31–5.
Letter to the Editor
Is coronary revascularization necessary for patients with well-developed coronary collaterals and coronary artery disease? Ersan Tatli ⁎, Mutlu Buyuklu Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey Received 20 November 2006; accepted 31 December 2006 Available online 16 April 2007
Keywords: Coronary collaterals; Coronary revascularization; Prognosis; Coronary artery disease
Coronary collaterals, or “natural bypasses,” are anastomotic connections without an intervening capillary bed between portions of the same coronary artery and between different coronary arteries [1]. They can be visualized on coronary angiography and they potentially offer an important alternative source of blood supply when the original vessel fails to provide sufficient blood [2]. Coronary collaterals may limit infarct size, preserve viability, and prevent ventricular aneurysm formation during an episode of acute coronary occlusion. In patients with stable coronary artery disease, a decrease in ischemic events and a better prognosis have been reported when collaterals are present [3]. However, the relation between well-developed coronary collaterals and prognosis had not been researched exactly. Antoniucci et al. [4] published a study on the significance of preintervention angiographic evidence of coronary collateral circulation in patients with acute MI who underwent primary angioplasty or stenting within 6 h of symptom onset. At 6 months, the mortality rate was lower in patients with coronary collateral circulation compared with patients without collaterals, without clear effects on clinical outcomes. Hendrick et al. [5] researched the relation between collaterals and cardiac death or myocardial infarction at 1 year after coronary revascularization (stent implantation and bypass grafting). They found that the presence of collaterals protected against cardiac death and myocardial infarction in patients with a low risk profile. These studies have compared mortality between the patients who were
⁎ Corresponding author. Tel.: +90 2842357641/2150, +90 5056789099 (GSM); fax: +90 2842357652. E-mail address: [email protected] (E. Tatli). 0167-5273/$ - see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.12.075
undergone coronary revascularization. Can mortality difference be between patients with well-developed coronary collaterals who were undergone coronary revascularization or not? When the question is answered, maybe we will not need coronary revascularization in patients with well-developed coronary collaterals and coronary artery disease. We are looking forward to the comments of editors about this subject. References [1] Popma JJ, Bittl J. Coronary angiography and intravascular ultrasonography. In: Braunwald E, Zipes DP, Libby P, editors. Heart disease: a textbook of cardiovascular medicine. Philadelphia: W.B. Saunders Company; 2001. p. 387–418. [2] Sasayama S, Fujita M. Recent insights into coronary collateral circulation. Circulation 1992;85:1197–204. [3] Ishihara M, Inoue I, Kawagoe T, et al. Comparison of the cardioprotective effect of prodromal angina pectoris and collateral circulation in patients with a first anterior wall acute myocardial infarction. Am J Cardiol 2005;95:622–5. [4] Antoniucci D, Valenti R, Moschi G, et al. Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction. Am J Cardiol 2002;89:121–5. [5] Hendrick N, Jeroen K, Erik B, et al. Determinants and prognostic significance of collaterals in patients undergoing coronary revascularization. Am J Cardiol 2006;98:31–5.