Comparison of coronary collateral circulation in diabetic and nondiabetic patients suffering from coronary artery disease.
OBJECTIVE
Although it is well established that diabetes mellitus (DM) induces more severe coronary artery disease (CAD), it is not known whether it contributes to the development of coronary collateral circulation. The present study examines coronary collateral circulation in diabetic and nondiabetic patients with angiographically verified CAD.


METHODS
The study group consisted of 463 diabetic patients (382 men, 81 women) with a mean age of 60.3 +/- 8.8 years, and 227 nondiabetic subjects (159 men, 68 women) with a mean age of 59.2 +/- 9 years. The extension and functional capacity of coronary collateral circulation was assessed according to the Cohen and Rentrop grading system of 0 to III.


RESULTS
We found that diabetic patients had grade III collateral circulation more frequently than nondiabetic subjects (13.2 vs. 8.5%, p < 0.01). This finding was even more pronounced in diabetic men aged < 55 years compared with both nondiabetic men (20 vs. 3.4%, p < 0.001) and diabetic women (20 vs. 2.2%, p < 0.001). Grade III collateral circulation was found to develop mainly at the left anterior descending (LAD) coronary artery and the right coronary artery (RCA), where complete occlusions of coronary arteries usually occur.


CONCLUSIONS
Diabetic patients with CAD develop more extensive coronary collateral circulation than nondiabetic subjects, especially men aged < 55 years. The collateral circulation mainly develops at the LAD and RCA.
Diabetic Unit, Tzanio Hospital, Piraeus, Greece.
A
A
Melidonis
S
S
Tournis
G
G
Kouvaras
E
E
Baltaretsou
S
S
Hadanis
I
I
Hajissavas
A
A
Tsatsoulis
S
S
Foussas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003097:Collateral Circulation; D003326:Coronary Circulation; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors