Determinants Of Collateral Development And Angiographic Study Of The Collateral Circulation's Distribution In Qingdao's Patients With Obstructive Coronary Disease

Objective According to definition, collateral circulation is an alternative to major vascular flow which has become dysfunctional. Collateral channels, initially unused, are being formed due to impossibility of the main blood vessel to provide normal coronary flow. The Angiographic study of coronary collaterals and the determinants of collateral development in the presence of obstructive coronary artery disease are not clearly defined in china. The aim of this work is to analyse the collateral pathways of coronary arteries and the determinants of collateral development in Qingdao's patients with obstructive coronary disease.Methods A cohort of 265 patients with 75% luminal diameter stenosis involving at least one major coronary artery diagnosis drawn from 694 patients by selective coronary angiography was retrospectively analysed angiographic features and interaction between coronary artery stenosis, age, sex, diabetes with coronary microcirculation from January 1997 to March 2002. Patients with valvular heart disease, congenital heart disease, cardiomyopathy, and pulmonary heart disease were excluded from the study. The patients were divided into two groups based on artery stenosis degree, than three groups on age of 55 and 65 years old, than four subgroups on diabetes mellitus and age. The extension and functional capacity of coronary collateral circulation was assessed according to the Cohen and Rentrop grading system of 0 to DI.Results 265 patients were reviewed [mean age 61. 4+15. 6 years (range 34-79), 210 manj. Collaterals were much more likely in patients with stenoses of >98% than 75%~98% ( = 14. 43 P<0. 001). The richest collateral supply was to the right coronary (59.3%), followed by collaterals to the left anterior descending (48,9%), the poorest supply was to the left circumflex (37. 3%). There are statistically significantdifference in percentage of collateral circulation distribution among three investigation group(x2 = 4. 43 =4. 28 P<0. 05). The prevalence of collateral circulation in middle group being significantly higher than younger and older groups. A significantly greater collateral proportion in women than men on old group (age >65 years old).Diabetes mellitus has negative relationship with collateral vessel formation. But in man aged <55 years. Diabetic patients with CAD develop more extensive coronary collateral circulation than nondiabetic subjects. 8 collateral pathways for the right coronary artery, 8 for the anterior descending artery, and 5 for the circumflex artery were found. These collateral circulation pathways have been mapped. Compared with Levin's literature, there are statistic values in right coronary artery investigation group C2 =9. 68, P< 0.01), left-anterior descending artery investigation groupC2 = 41. 73,P<0. 001) and left-circumflex artery investigation group(2=8. 54 P<0. 01).Conclusions Results of this study demonstrate that there is an association be-tweencollateral vessels in Qingdao's patients with obstructive coronary disease with the extensity of stenotic lesions, age, sex, and diabetes mellitus. The collateral circulation's distribution in Qingdao's patients with obstructive coronary disease had significant difference compared to those of correlative literature.