Abstract
Background: Coronary artery disease is highly prevalent in India with onset at a younger age. Coronary collateral circulation plays an important role in protecting myocardium from infarction, preserving myocardial contractility and reducing cardiovascular events. The objective of the present study is to assess the pattern of coronary collateral circulation in known cases of coronary artery disease with correlation to age, gender and degree of occlusion. Method: This is a retrospective study done on 200 preoperative angiograms in patients with coronary artery disease. Patients were classified according to age, gender and degree of obstruction in major vessels. Collateral vessels were graded according to the Rentrop classification. Patients with collaterals were further classified on the basis of intensity of collaterals into 3 groups: those with no collateralization (Grade 0), poor collateralization (Grade 1) and those with adequate collateralization (Grade 2 - 3). Results: Collateral development was seen in 175 (87.5%) angiograms. Collaterals were seen in 66% for left anterior descending (LAD), 44.5% for circumflex (LCx) and 70.5% for right coronary artery (RCA) block. Coronary collaterals between LAD and posterior descending artery (PDA) via ventricular septal branches were most common pathways. Adequate collaterals were seen in 53% males and 29.3% females (p 50 years and in 32% in cases with age p = 0.014) and 54.8% cases with arterial obstruction > 90%. Conclusion: Collateral circulation between LAD and PDA via ventricular septal branches is the commonest pathway to develop. Although prevalence of LAD occlusion is higher but collaterals develop more for RCA occlusion. Adequate collaterals develop more frequently in males, cases above 50 years and in vessels with >90% obstruction.
Highlights
Coronary collaterals, or “natural bypasses”, are anastomotic connections without an intervening capillary bed either between portions of the same coronary artery or different coronary arteries [1]
Population average age of female patients was 60.89 ± 8.56 years and there was only one woman with age less than 50 years who was suffering from diabetes mellitus while remaining female patients were above fifty years, development of adequate collaterals in less number of females could be due to decreased angiogenic response in post-menopausal women
Our findings are similar to those found in another study done on diabetes and non-diabetics which stated that Grade 3 collaterals were more prevalent when collateral development was in males < 55 years than in females of same age [15]
Summary
“natural bypasses”, are anastomotic connections without an intervening capillary bed either between portions of the same coronary artery or different coronary arteries [1]. The human coronary collateral circulation is speculated to play an important role in preserving myocardial function in the presence of obstructive coronary artery disease [3] [4] [5]. There is no study which describes any differences in pattern of coronary collateral circulation in patients with coronary artery disease requiring surgical revascularization in this region, the present study was planned with an objective to study the patterns of coronary collaterals pathways extensively and find their correlation with demographic features in North West region of India. The objective of the present study is to assess the pattern of coronary collateral circulation in known cases of coronary artery disease with correlation to age, gender and degree of occlusion. Coronary collaterals between LAD and posterior descending artery (PDA) via ventricular septal branches were most common pathways.
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