Coronary Collaterals and Risk for Restenosis After Percutaneous Coronary Interventions: A Meta-Analysis Full Text
BMC Medicine, 06/26/2012
Evidence Based Medicine
Meier P et al. – The risk of restenosis after Percutaneous Coronary Interventions (PCI) is increased in patients with good coronary collateralization. Assessment of the coronary collateral circulation before PCI may be useful for risk stratification and for the choice of anti–proliferative measures (drug–eluting stent instead bare–metal stent, Cilostazol).Methods
- The authors searched MEDLINE, EMBASE, ISI Web of Science (2001 to July 15, 2011).
- Random–effects models were used to calculate summary risk ratios (RR) for restenosis.
- Primary endpoint was angiographic restenosis >50%.
- A total of 7 studies enrolling 1,425 subjects were integrated in this analysis.
- On average across studies, the presence of a good collateralization was predictive for restenosis (risk ratio RR 1.40 [95% confidence interval 1.09 – 1.80]; p= 0.009).
- This risk ratio was consistent in the subgroup analyses where collateralization was assessed with intracoronary pressure measurements (RR 1.37 [1.03 – 1.83]; p=0.038) versus visual assessment (RR 1.41 [1.00 – 1.99]; p=0.049).
- For the subgroup of patients with stable CAD, the RR for restenosis with "good collaterals" was 1.64 [1.14 –2.35] compared to "poor collaterals"(p=0.008).
- For patients with acute myocardial infarction, however, the RR for restenosis with "good collateralization" was only 1.23 [0.89 – 1.69]; p= 0.212).