Journal of Clinical and Preventive Cardiology (Jan 2021)
Coronary collateral circulation in acute, subacute, and chronic total occlusions
Abstract
Context: A study on the pattern of coronary collateral circulation is relevant in coronary artery disease (CAD) where despite advances in revascularization, the prevalence of heart failure is increasing. Aims: The aim was to study the pattern of coronary collateral circulation in acute, subacute, and chronic coronary total occlusions and to find out the association between collateral grade with the severity of CAD. Settings and Design: This was a hospital-based retrospective cross-sectional study of 141 patients with acute, subacute, or chronic total occlusion of coronaries detected by coronary angiography. Subjects and Methods: Data of 141 patients with total occlusion of coronaries detected by coronary angiography were analyzed. Collateral grading was done according to the Rentrop classification and Werner classification. The severity of CAD was assessed using Gensini score and Syntax score. Pattern of collateral circulation in different types of coronary occlusions and the association between collateral grade and severity of CAD were assessed. Statistical Analysis Used: The association of categorical clinical and angiographic features with type of occlusion was tested using Chi-square test and that of continuous variable with student t-test. All tests were two tailed and P < 0.05 was considered statistically significant. Results: Young patients presented predominantly with acute coronary occlusions (82.6%). About 73% of the patients with left ventricle (LV) dysfunction had acute coronary occlusions. Nearly 68.8% of patients with poor Rentrop collateral grades had LV dysfunction. Patients with acute occlusion had low atherosclerotic burden as evidenced by lower Gensini and Syntax scores and had poor coronary collaterals. No significant correlation was seen between Gensini and Syntax scores and collateral grade. Patients who presented with ST-elevation myocardial infarction (STEMI) had poor Rentrop collaterals and higher prevalence of single-vessel disease and double-vessel diseases when compared to those with non-ST-segment elevation acute coronary syndrome and chronic stable angina. Conclusions: Young male patients with low atherosclerotic burden tend to present with acute coronary occlusions. This subgroup has poor collateral circulation and LV dysfunction. No statistically significant difference was seen in the presence of diabetes, hypertension, number of epicardial coronary artery involvement, or the severity of CAD in the STEMI patients with good or poor Rentrop collaterals.
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