Impacts of Antihypertensive Drugs on Coronary Collateral Development

Abstract

Purpose: Increase in the number of coronary imaging has caused us to encounter patients with chronic total occlusion (CTO) more often in daily practice. Although clinical trials have demonstrated the importance of collateral circulation, which has significant functions in ischemic myocardial cells, factors affecting the development of collateral circulation remain unclear. Our study aimed to investigate the impact of antihypertensive drugs on collateral development.

Materials and Methods: Our retrospective cohort study included 107 patients who were detected to CTO as a result of coronary angiography (CAG) and had been regularly taking the antihypertensive drug for more than six months. The patients were divided into two groups according to the Rentrop classification.

Results: Statistically well-developed collaterals were observed in patients using angiotensin-converting enzyme (ACE) inhibitors for more than six months (p<0.001). The multivariate regression analysis showed that among the medicines, the use of ACE inhibitors is associated with well-developed collaterals (Odds ratio [OR]:7.500, 95% confidence interval [CI]: 2.345-23.984, p=0.001).

Conclusion: Using ACE inhibitor for more than six months affects coronary collateral development positively. The ACE inhibitor group should be prioritized when choosing the antihypertensive drug because they will contribute to collateral development in CTO patients who are considered for a medical follow-up.

Keywords

• ACE inhibitors
• coronary artery disease
• coronary collateral circulation

Antihipertansif İlaçların Koroner Kollateral Gelişimi Üzerine Etkileri

Abstract

Amaç: Koroner görüntüleme sayılarındaki artış kronik total oklüzyon (KTO) hastalarıyla günlük pratikte daha çok karşılaşmamıza neden olmuştur. İskemik miyokart hücrelerinde önemli fonksiyonları olan kollateral dolaşımın önemi klinik araştırmalarda gösterilmesine rağmen, kollateral dolaşımın gelişimini etkileyen faktörler net değildir. Çalışmamızda, antihipertansif ilaçların kollateral gelişimine etkisi araştırılmak amaçlanmıştır. 

Araçlar ve Yöntem: Çalışmamız retrospektif kohort çalışması olup koroner anjiografi (KAG) sonucunda KTO tespit edilen ve 6 aydan uzun süredir düzenli antihipertansif ilaç kullanan 107 hasta dahil edildi. Hastalar, Rentrop sınıflandırmasına göre iki gruba ayrıldı.

Bulgular: 6 aydan uzun süreli anjiotensin dönüştürücü enzim (ADE) inhibitörleri kullanan hastalarda istatiksel olarak iyi gelişmiş kollateraller görüldü (p<0.001). Çok değişkenli regresyon analizi sonucunda ise ilaçlar arasında ADE inhibitörü kullanımının iyi kollateral gelişimi ile ilişkisi gösterilmiştir (Odds oranı [OO]: 7.500, %95 güven aralığı [GA]: 2.345-23.984, p=0.001).

Sonuç: Altı aydan daha fazla ADE inhibitörü kullanıldığında koroner kollateral gelişimini olumlu etkilemektedir. Medikal izlem düşünülen KTO hastalarında kollateral gelişimine katkı sağlayacağından antihipertansif ilaç tercihinde ADE inhibitörü grubu öncelikle tercih edilmelidir.

Keywords

• ADE inhibitörleri
• koroner arter hastalığı
• koroner kollateral dolaşım

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