The association of angiographic collaterals with long-term clinical outcomes in patients with chronic stable angina.

OBJECTIVES

To determine the impact of coronary collaterals in stable angina.

BACKGROUND

Whether spontaneously visible coronary collaterals are associated with long-term clinical outcomes in stable angina remains unclear.

METHODS

We prospectively enrolled patients with stable angina referred for coronary angiography and followed them clinically for 1 year.

RESULTS

A total of 1,134 consecutive patients were enrolled, and of these, 550 had at least single-vessel coronary artery disease (CAD) and were included. Patients with collaterals had more congestive heart failure (16% vs. 9%, P = 0.023), peripheral vascular disease (22% vs. 15%, P = 0.044), and 2-vessel (36% vs. 26%) and 3-vessel (28% vs. 10%) CAD compared to those without collaterals (P < 0.001). Patients with collaterals were less likely to undergo percutaneous intervention at the time of the index angiogram (32% vs. 61%, P < 0.001). At 1 year, there were no differences in angina (HR 0.74, 95% CI 0.50-1.10; P  = 0.141), myocardial infarction (MI) (HR 1.22, 95% CI 0.46-3.21; P = 0.691), revascularization (HR 0.84, 95% CI 0.55-1.30; P = 0.431), death (HR 1.83, 95% CI 0.63-5.31; P =  0.269), or the combined end-point of death, MI, and revascularization (HR 0.87, 95% CI 0.61-1.24; P = 0.426) between patients with and without collaterals. When analyzed according to collateral grade, patients with Rentrop grade 1 had less angina (HR 0.48, 95% CI 0.26-0.89; P  = 0.019).

CONCLUSIONS

At 1 year, there was no difference in adverse events between patients with or without collaterals. The presence of Rentrop grade 1 collaterals, however, was associated with significantly less angina.