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European Heart Journal Advance Access originally published online on April 24, 2007
European Heart Journal 2007 28(15):1820-1826; doi:10.1093/eurheartj/ehm067
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

Lisette Okkels Jensen1,*, Per Thayssen1, Jens Flensted Lassen2, Henrik Steen Hansen1, Henning Kelbæk3, Anders Junker1, Knud Erik Pedersen1, Knud Nørregaard Hansen1, Lars Romer Krusell2, Hans Erik Botker2 and Leif Thuesen2

1 Department of Cardiology, Catheterization Laboratory, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
2 Department of Cardiology, Aarhus University Hospital, Skejby Sygehus, Aarhus, Denmark
3 Department of Cardiology, Rigshospitalet, Copenhagen, Denmark

Received 1 August 2006; revised 24 February 2007; accepted 8 March 2007; online publish-ahead-of-print 24 April 2007.

* Corresponding author. Tel: +45 6541 2691; fax: +45 6312 1730. E-mail address: okkels{at}dadlnet.dk

Aims: Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment.

Methods and results: In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure-derived collateral flow index (CFI) was determined as (Pw–Pcvp)/(Pa–Pcvp), where Pw represents coronary wedge pressure, Pcvp central venous pressure, and Pa mean aortic blood pressure. Both were measured during transient coronary occlusion by a balloon inflation of 30 s. Pre-interventional FFR (0.65 ± 0.20) correlated inversely with the CFI (0.18 ± 0.11), r =– 0.356, P < 0.001. After 9 months, binary angiographic restenosis (≥50% diameter stenosis) was seen in 29.1%. Compared to patients with poorly developed collaterals (CFI < 0.25), patients with well-developed collaterals (CFI ≥ 0.25) had a lower pre-interventional FFR (0.50 ± 0.14 vs. 0.72 ± 0.18, P < 0.001), a higher CFI (0.33 ± 0.08 vs. 0.13 ± 0.07, P < 0.001), and a higher binary restenosis rate (54.2% vs. 19.4, P = 0.003). CFI*100 was an independent predictor of restenosis after 9 months (odds ratio 1.07, 95% CI 1.02–1.12, P = 0.016).

Conclusion: Recruitable collateral blood flow measured during balloon inflation predicts angiographic instent restenosis in PCI patients treated with bare metal stents.

Key Words: Collaterals • Restenosis • Stent • Fractional flow reserve


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