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The prognostic impact of the coronary collateral circulation in patients with coronary artery disease: A meta-analysis

Background: Coronary Collateral Circulation (CCC) is an alternative source of blood supply to an ischemic myocardial region. The study of animal models showed that coronary collateral circulation on the myocardial had obvious protective effect of survival but it for humans the influence of the prognosis was still controversial.

Aims: The aim of this meta-analysis is to explore the impact of collateral circulation on prognosis.

Methods and Results: We performed an electronic literature search of PubMed, Embase, Chinese Biomedical Database (CBM), China National Knowledge Infrastructure (CNKI) Cochrane Library, assessed the association between coronary collateral circulation and prognosis, searched from the 1989 up to July 2016, there was no language restriction. A total of 16 studies enrolling 16447 participants were included in this analysis. Patients with high collateralization showed a reduced mortality compared with those with low collateralization Risk Ratios (RR) 0.66 [95% Confidence Intervals (CI) 0.54-0.82]; P=0.0001). The RR for ‘high collateralization’ showed a reduced incidence of re-infarction compared with those with low collateralization was 0.69 (95% CI: 0.52~0.92 p=0.01), in patients with Major Adverse Cardiovascular Events (MACE), it was (RR 0.62 [95% CI 0.46–0.84], p=0.002).

Conclusions: Abundant collateral circulation could reduce coronary heart disease mortality, recurrence of myocardial infarction and adverse cardiovascular events. However, in the revascularization, arrthythmia, cardiac death and so on, showed not reach statistical significance.

Author(s): Huizheng Zhu, Yudan Liang, Tian Zuo, Minzhou Zhang