Collateral formation in patients after percutaneous myocardial revascularization: a mechanism for improvement?
BACKGROUND
Percutaneous myocardial revascularization (PMR) has emerged as a novel therapeutic strategy for patients with ischemic heart disease not amendable to traditional revascularization approaches. Despite the symptomatic improvement documented in clinical trials, underlying mechanism remains unknown.


METHODS
We assessed the coronary angiograms of 25 patients before and 6 months after the PMR procedures for collateral vessel formation. The Rentrop scoring system was used to score the extent of collateral vessel formation. The angiograms were analyzed by 2 independent reviewers. The change in Rentrop score and improvement in angina status was correlated.


RESULTS
During follow-up period of 6 months, no patient died or suffered from myocardial infarction. Overall the mean Canadian Classification Society (CCS) class among the study patients was significantly improved from 3.5 to 2.4; mean difference = 1.08 (p < 0.0001). Among these, 8 (32%) had improvement of > 2 CCS classes (p = 0.003) (improvement group). The rest of the patients had either no change (n = 8; 32%) or improvement of 1 CCS class (n = 9; 36%) (no improvement group). The Rentrop score improved in 3 (12%), remained unchanged in 22 (88%) and deteriorated in 0 patient. Overall, there was no significant change in Rentrop score at 6-month follow-up; mean difference 0.13 (p = 0.08). There was also no correlation between the change in extent of collateral vessel formation and the improvement in angina status (correlation coefficient r = 0.09) at 6 months after PMR.


CONCLUSIONS
Improvement in collateral vessel formation is unlikely to be a mechanism responsible for symptomatic improvement in patients after PMR.
Lee
Chi Hang
CH
Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands.
Smits
Pieter C
PC
Tanabe
Kengo
K
van Domburg
Ron T
RT
Degertekin
Muzaffer
M
van der Giessen
Wim
W
Serruys
Patrick W
PW
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods*; D016896:Treatment Outcome