Copyright © 2003 by the European Society of Cardiology.
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Impaired acute collateral recruitment as a possible mechanism for increased cardiac adverse events in patients with diabetes mellitus
Clinic for Internal Medicine III, Friedrich-Schiller-University, Jena, Germany
* Correspondence: Gerald S. Werner, MD, Klinik für Innere Medizin III, Friedrich-Schiller-University, Erlanger Allee 101, D-07740 Jena, Germany. Tel: 1149-3641-939538; fax: 1149-3641-939363
E-mail address: gerald.werner{at}med.uni-jena.de
Received 3 October 2002; revised 7 December 2002; accepted 21 February 2003
Background The mortality of coronary artery disease is increased in diabetic patients. An impaired collateral function is considered a possible explanation. This study should assess the influence of diabetes on collaterals by direct invasive assessment of collateral function.
Methods In 90 consecutive patients with a chronic coronary occlusion (TCO) of >2 weeks duration a recanalization was done. Thirty patients with diabetes (33%) were compared with 60 (67%) without diabetes. Blood flow velocity and pressure were measured distal to the occlusion by intracoronary Doppler and pressure wires before PTCA, and again after PTCA during a final balloon reocclusion to assess acute recruitment of collaterals. Resistance indexes for collaterals (RColl) and peripheral microcirculation (RP) were calculated.
Results The RColl(diabetics: 8.1±6.8 vs nondiabetics: 8.7±6.7mmHgcm–1s–1; p=0.68) and RP(5.6±4.2 vs 6.6±3.8mmHgcm–1s–1; p=0.30) were similar in diabetic and nondiabetic patients before recanalization. During balloon reocclusion both RColland RPincreased. This increase was significantly more pronounced in diabetic than in nondiabetic patients in TCOs <3 months duration. In TCOs of longer duration (
3 months) these differences were no longer detectable between both patient groups.
Conclusions Diabetic patients with TCOs have similarly developed collaterals as nondiabetic patients. However, in TCOs <3 months duration the acute recruitment of collaterals in case of reocclusion is impaired. This could explain some of the higher complication rate and mortality after coronary interventions in diabetic patients.
Key Words: Chronic coronary occlusion • Collateral circulation • Diabetes mellitus • Percutaneoustransluminal angioplasty • Intracoronary Doppler
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