CLINICAL, ANGIOGRAPHIC AND HEMODYNAMIC PREDICTORS OF RECRUITABLE COLLATERAL FLOW ASSESSED DURING BALLOON ANGIOPLASTY CORONARY-OCCLUSION

Objectives. We sought to determine the predictive value of factors inf luencing coronary collateral vascular responses in humans, Background. There is limited information on the factors responsible for coronary collateral vascular development, despite the protective effect of coll ateral vessels in ischemic syndromes, Methods. Angiography of the cont ralateral artery was performed during balloon coronary occlusion in 10 5 patients with single-vessel disease (left anterior descending corona ry artery in 69 patients, left circumflex coronary artery in 4 patient s, right coronary artery in 32 patients) and normal left ventricular f unction, Collateral vessels were graded according to the classificatio n of Rentrop, The relative collateral vascular resistance was calculat ed in a subgroup of 34 patients by means of aortic pressure, coronary wedge pressure and collateral how, defined as the transient increase o f coronary blood flow velocity of the contralateral artery during ball oon coronary occlusion, Ischemia during coronary occlusion was evaluat ed by the ST segment shift (mV) in a 12-lead electrocardiogram (EGG), Results, A multivariate logistic analysis of clinical and angiographic variables revealed duration of angina (greater than or equal to 3 mon ths, p < 0.0001), lesion severity (greater than or equal to 75% diamet er stenosis, p < 0.0001) and proximal lesion location (p = 0.02) as in dependent factors positively associated with recruitability of collate ral vessels, whereas the use of nitrates exerted an independent negati ve effect (p = 0.01), The regression equation yielded an overall predi ctive accuracy of 80%, The presence of recruitable collateral vessels during coronary occlusion resulted in a higher coronary wedge/aortic p ressure ratio (mean [+/-SD] 0.35 +/- 0.13 vs, 0.27 +/- 0.12, p < 0.005 ), a lower relative collateral vascular resistance (6.7 +/- 7.4 vs, 21 .3 +/- 10, p < 0.001) and a reduction of ECG signs of ischemia (0,14 /- 0.19 vs, 0.38 +/- 0.33 mV, p < 0.001), The relative collateral vasc ular resistance was the best predictor for recruitability of collatera l vessels compared with the other variables related to collateral vasc ular growth (p < 0,05), Conclusions. Clinical and angiographic variabl es predict recruitability of collateral vessels with an 80% overall ac curacy, These findings are important for risk stratification of patien ts undergoing interventions for ischemic coronary syndromes. (C) 1997 by the American College of Cardiology.