Key result
Well-developed collaterals in single-vessel CTO PCI are linked to ~52% lower 5-year cardiac death.
Why the study?
The prognostic value of coronary collateral circulation in patients undergoing chronic total occlusion PCI is underdetermined.
Does well-developed collateral circulation reduce 5-year cardiac death in patients with single-vessel CTO undergoing PCI?
Observational (n=2,452)
Does well-developed collateral circulation reduce 5-year cardiac death in patients with single-vessel CTO undergoing PCI?
Answers are grounded in this paper and cite their sources.
Well-developed collateral circulation defined by Werner's grading system, but not the Rentrop system, is associated with a lower rate of 5-year cardiac death in patients undergoing PCI for single-vessel CTO.
BACKGROUND The prognostic value of coronary collateral circulation (CC) in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is underdetermined. The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI. METHODS We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December 2013. All patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner’s CC (grade 2 vs. grade 0–1) or Rentrop (grade 3 vs. grade 0–2) grading system. The primary endpoint was 5-year cardiac death. RESULTS Of 2452 enrolled patients, the overall technical success rate was 74.1%. Well-developed collaterals were present in 686 patients (28.0%) defined by Werner’s CC grade 2, and in 1145 patients (46.7%) by Rentrop grade 3. According to Werner’s CC grading system, patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poor-developed collaterals (1.6% vs. 3.3%, P = 0.02), those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization (4.7% vs. 0.8%, P = 0.01) and failure patients (4.7% vs. 1.6%, P = 0.12). However, the similar effect was not shown in Rentrop grading system. CONCLUSIONS In patients with the single-vessel CTO underwent PCI, well-developed collaterals by Werner’s CC definition were associated with lower rate of 5-year cardiac death. Werner’s CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.
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Hu et al. (2024) conducted an observational in Single-vessel chronic total occlusion (CTO) (n=2,452). Well-developed collaterals (Werner's CC grade 2) vs. Poor-developed collaterals (Werner's CC grade 0-1) was evaluated on 5-year cardiac death (p=0.02). Well-developed collaterals (Werner's CC grade 2) in single-vessel CTO patients undergoing PCI were associated with lower 5-year cardiac death than poor-developed collaterals (1.6% vs 3.3%, P=0.02).
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