Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

BMC Medicine

Research Article

Andreas Indermuehle¹  Tobias Traupe²  Christian Seiler²  Bertram Pitt³  Stefano F de Marchi⁴  Alexandra J Lansky⁵  Guido Knapp⁶  Tom Crake⁷  Pascal Meier⁷ 

[1] Department of Cardiology, St Thomas' Hospital, King's College London, UK;Department of Cardiology, University Hospital Bern, Bern, Switzerland;Department of Cardiology, University of Michigan Medical Center, Ann Arbor, MI, USA;Department of Cardiology, University of Oslo, Oslo, Norway;Department of Cardiology, Yale University Medical Center, New Haven, CT, USA;Department of Statistics, TU University Dortmund, Dortmund, Germany;The Heart Hospital London, University College London Hospital Trust, London, UK;

关键词: coronary collateral circulation;    meta-analysis;    restenosis;    therapy failure;   

DOI  :  10.1186/1741-7015-10-62

 received in 2011-08-17, accepted in 2012-06-21,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundThe benefit of the coronary collateral circulation (natural bypass network) on survival is well established. However, data derived from smaller studies indicates that coronary collaterals may increase the risk for restenosis after percutaneous coronary interventions. The purpose of this systematic review and meta-analysis of observational studies was to explore the impact of the collateral circulation on the risk for restenosis.MethodsWe searched the MEDLINE, EMBASE and ISI Web of Science databases (2001 to 15 July 2011). Random effects models were used to calculate summary risk ratios (RR) for restenosis. The primary endpoint was angiographic restenosis > 50%.ResultsA total of 7 studies enrolling 1,425 subjects were integrated in this analysis. On average across studies, the presence of a good collateralization was predictive for restenosis (risk ratio (RR) 1.40 (95% CI 1.09 to 1.80); P = 0.009). This risk ratio was consistent in the subgroup analyses where collateralization was assessed with intracoronary pressure measurements (RR 1.37 (95% CI 1.03 to 1.83); P = 0.038) versus visual assessment (RR 1.41 (95% CI 1.00 to 1.99); P = 0.049). For the subgroup of patients with stable coronary artery disease (CAD), the RR for restenosis with 'good collaterals' was 1.64 (95% CI 1.14 to 2.35) compared to 'poor collaterals' (P = 0.008). For patients with acute myocardial infarction, however, the RR for restenosis with 'good collateralization' was only 1.23 (95% CI 0.89 to 1.69); P = 0.212.ConclusionsThe risk of restenosis after percutaneous coronary intervention (PCI) is increased in patients with good coronary collateralization. Assessment of the coronary collateral circulation before PCI may be useful for risk stratification and for the choice of antiproliferative measures (drug-eluting stent instead bare-metal stent, cilostazol).

【 授权许可】

CC BY   
© Meier et al; licensee BioMed Central Ltd. 2012