Abstract
BackgroundCoronary collateral circulation plays an important role to protect myocardium from ischemia, preserve myocardial contractility and reduce cardiovascular events. Chronic kidney disease (CKD) is associated with poor coronary collateral development and cardiovascular outcome. However, limited research investigates the predictors for collateral development in the CKD population.MethodsWe evaluated 970 consecutive patients undergoing coronary angiography and 202 patients with CKD, defined as a glomerular filtration rate less than 60 ml/min/1.73 m2, were finally analyzed. The collateral scoring system developed by Rentrop was used to classify patients into poor (grades 0 and 1) or good (grades 2 and 3) collateral group.ResultsThe patients with poor collateral (n = 122) had a higher incidence of hypertension (82% vs 63.8%, p = 0.005), fewer diseased vessels numbers (2.1 ± 0.9 vs 2.6 ± 0.6, p < 0.001) and a trend to be diabetic (56.6% vs. 43.8%, p = 0.085) or female sex (37.7% vs. 25.0%, p = 0.067). Multivariate analysis showed hypertension (odd ratio (OR) 2.672, p = 0.006), diabetes (OR 1.956, p = 0.039) and diseased vessels numbers (OR 0.402, p < 0.001) were significant predictors of poor coronary collaterals development. Furthermore, hypertension and diabetes have a negative synergistic effect on collateral development (p = 0.004 for interaction).ConclusionsIn the CKD population hypertension and diabetes might negatively influence the coronary collaterals development.
Highlights
Coronary collateral circulation plays an important role to protect myocardium from ischemia, preserve myocardial contractility and reduce cardiovascular events
There is no research discussing about the predictors of poor collaterals in the Chronic kidney disease (CKD) population with significant coronary artery disease (SCAD)
Clinical characteristics Among the 970 subjects initially evaluated, 768 patients were excluded for the following reasons: coronary artery lumen diameter stenosis
Summary
Coronary collateral circulation plays an important role to protect myocardium from ischemia, preserve myocardial contractility and reduce cardiovascular events. Chronic kidney disease (CKD) is associated with poor coronary collateral development and cardiovascular outcome. Two major poor outcomes of CKD are progression to end-stage renal disease and development of cardiovascular disease (CVD) [2]. Collateral circulation can protect and preserve myocardium from episodes of ischemia, enhance residual myocardial contractility, and reduce angina symptoms and cardiovascular events [10,11,12]. Chronic kidney disease is associated with poor coronary collateral vessel development in the literature [13,14]. There is no research discussing about the predictors of poor collaterals in the CKD population with significant coronary artery disease (SCAD).
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