ACADEMIC AND RESEARCH PEER-REVIEWED MEDICAL JOURNALISSN 1727-2378 (Print)         ISSN 2713-2994 (Online)
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The Influence of the Coronary Collateral Circulation on Mortality in Patients with Chronic Ischemic Heart Disease

Bibliography link: Kozlova E. V., Starostin I. V., Balatsky A. V., Jain M., Bulkina O. S., Lopukhova V. V., Karpov Yu. A. The Influence of the Coronary Collateral Circulation on Mortality in Patients with Chronic Ischemic Heart Disease. Doctor.Ru. 2017. 10(139): 8–14.
20 October 00:00

Study Objective: To study the influence of the coronary collateral circulation (CCC) on the survival of patients with stable ischemic heart disease (IHD), based on five years of observation; and to identify genetic polymorphisms associated with the development of CCC and the survival of patients with chronic IHD.

Study Design: This was a prospective observational cohort study.

Materials and Methods: The study included 597 patients with stable IHD whose routine coronary angiography (CA) had shown ≥50% stenosis in at least one coronary artery measuring ≥1.5 mm in diameter. The grade of CCC was assessed by a modified Rentrop method. The study subjects were 157 women and 440 men, aged 34 to 87 (61.6 [55-70]). Forty-three patients (7.2%) were lost to follow-up. The statistical analysis was done using data collected from 554 patients.

Patients were examined for the rs2227564 single-nucleotide polymorphism (SNP) in the urokinase-type plasminogen activator gene (PLAU) and the rs5745572 SNP in the hepatocyte growth factor (HGF) gene. Clinical disease course and mortality were assessed five years after the index CA. This paper analyzes only mortality.

Study Results: Univariate analysis (log rank) showed that the PLAU rs2227564 was associated with all-cause mortality (р = 0.01), whilch was confirmed by multivariate analysis (HR 4.8; р = 0.01). The following parameters were independent predictors of higher cardiac mortality: male gender (HR 6.46; 95% CI: 1.24-33.59; р = 0.027), reduced left ventricular ejection fraction (HR 0.9; 95% CI: 0.871-0.932; р < 0.00005), and elevated Syntax score (HR 1.05; 95% CI: 1.022-1.088; р = 0.001). A relationship was also found between a higher Thrombolysis in Myocardial Infarction (TIMI) score for antegrade coronary flow through a stenosis, and survival (HR 0.6; 95% CI: 0.4-0.8; р = 0.002).

Univariate and multivariate analysis found no relationship between the PLAU rs2227564 or HGF rs5745572 polymorphisms and the development of CCC. Univariate analysis (log rank) showed that the PLAU rs2227564 was associated with both all-cause (р = 0.01) and cardiac mortality (р = 0.09), while multivariate analysis confirmed its association only with all-cause mortality (HR 4.8; р = 0.01).

Conclusion: This five-year observational study showed that in patients with chronic IHD, including those who had undergone myocardial revascularization, good CCC was associated with lower cardiac and all-cause mortality. This association was independent of the severity of IHD or coronary bed disease and other mortality predictors.

E. V. Kozlova — National Medical Research Center for Cardiology, Moscow. E-mail: ekaterinavkozlova@yandex.ru

I. V. Starostin — National Medical Research Center for Cardiology, Moscow. E-mail: ivs_01@bk.ru

A. V. Balatsky — Lomonosov Moscow State University. E-mail: a.balatskiy@gmail.com

M. Jain — Lomonosov Moscow State University. E-mail: jain-mark@outlook.com

O. S. Bulkina — National Medical Research Center for Cardiology, Moscow. E-mail: olgabulkina@mail.ru

V. V. Lopukhova — National Medical Research Center for Cardiology, Moscow. E-mail: trialvvl@mail.ru

Yu. A. Karpov — National Medical Research Center for Cardiology, Moscow. E-mail: yuri_karpov@inbox.ru


Доктор.ру
20 October 00:00
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