Key result
Pharmacologic and non-pharmacologic interventions moderately improve coronary collateralization in patients with CAD.
Why the study?
Coronary collaterals supply blood to oxygen-deprived myocardium in CAD, but potential interventions to enhance the growth of these collateral vessels needed identification and evaluation.
Do pharmacologic and non-pharmacologic interventions improve coronary collateral circulation in patients with coronary artery disease?
Do pharmacologic and non-pharmacologic interventions improve coronary collateral circulation in patients with coronary artery disease?
Various pharmacologic and non-pharmacologic interventions, including exercise and enhanced external counter pulsation, show moderate positive effects on coronary collateralization in patients with CAD.
Moderate effects on collaterals with listed agents may merit targeted trials; leaves open outcome impact and routine use in CAD.
Background: Coronary collaterals are vascular connections that bridge epicardial arteries and supply blood to the oxygen-deprived myocardium in patients with coronary artery disease (CAD). This comprehensive review aimed to identify and evaluate potential interventions that may enhance the growth of coronary collateral vessels. Methods: We conducted a scoping review of five databases to identify relevant studies that focused on interventions that may promote coronary collateral circulation in patients with CAD. Results: Our search identified 23 studies that met our inclusion criteria. Studies (n=7) using pharmacologic agents (i.e., angiotensin-converting enzyme inhibitors, granulocyte macrophage colony stimulating factor, statins, human recombinant basic fibroblast growth factor, and granulocyte macrophage colony stimulating factor) were found to improve collateralization, as did the non-pharmacologic studies (n=13) (i.e., exercise training, electrical stimulation, and enhanced external counter pulsation), which formed most of the studies. Three studies found benefits of a combination of exercise and heparin. Improvements were seen in collateralization as measured by the coronary flow index and Rentrop scores across all interventions. Effect sizes from randomized trials with pharmacologic, non-pharmacologic, and exercise-based interventions ranged between 0.4-0.7. Conclusion: This review provides a comprehensive overview and update of the existing literature on interventions that may promote coronary collateralization (CC). In summary, we observed a few pharmacological and non-pharmacological (exercise, electrical stimulation, and enhanced external counter pulsation) interventions that have shown a positive effect on CC. These data provide a framework for more robust trials regarding the proliferation and clinical significance of enhanced CC in cardiovascular outcomes in patients with known or occult CAD.
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Shah et al. (2026) conducted a review in Coronary artery disease (CAD) (n=23). Pharmacologic, non-pharmacologic, and exercise-based interventions was evaluated on Coronary collateralization (measured by coronary flow index and Rentrop scores) (Effect sizes 0.4-0.7). Pharmacologic, non-pharmacologic, and exercise-based interventions improved coronary collateralization in patients with CAD, with effect sizes ranging from 0.4 to 0.7.
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