Impacts of Antihypertensive Drugs on Coronary Collateral Development

Yıl 2022, , 137 - 142, 30.08.2022

Uğur Küçük

https://doi.org/10.46332/aemj.985027

Öz

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.

Anahtar Kelimeler

ACE inhibitors, coronary artery disease, coronary collateral circulation

Antihipertansif İlaçların Koroner Kollateral Gelişimi Üzerine Etkileri

Öz

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.

Anahtar Kelimeler

ADE inhibitörleri, koroner arter hastalığı, koroner kollateral dolaşım

Kaynakça

• 1. Malakar AK, Choudhury D, Halder B, et al. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol. 2019;234(10):16812-16823.
• 2. Pezawas T, Diedrich A, Robertson D, et al. Risk of arrhythmic death in ischemic heart disease: a prospective, controlled, observer-blind risk stratification over 10 years. Eur J Clin Invest. 2017;47(3):231-240.
• 3. Nathoe HM, Koerselman J, Buskens E, et al. Determinants and prognostic significance of collaterals in patients un- dergoing coronary revascularization. Am J Cardiol. 2006;98(1):31-35.
• 4. Pohl T, Seiler C, Billinger M, et al. Frequency distribution of collateral flow and factors influencing collateral channel development. Functional collateral channel measurement in 450 patients with coronary artery disease. J Am Coll Cardiol. 2001;38(7):1872-1878.
• 5. Gürbüz AS, Alsancak Y, Öztürk S, ve ark. The relationship between coronary collateral circulation and serum endocan levels in patients with coronary chronic total occlusions. Koşuyolu Heart J. 2019;22(1):25-29.
• 6. Burnett H, Earley A, Voors AA, et al. Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction: A Network Meta-Analysis. Circ Heart Fail. 2017;10(1):e003529.
• 7. Sim HW, Zheng H, Richards AM, et al. Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization. Sci Rep. 2020;10(1): 15184.
• 8. Bairey Merz CN, Pepine CJ, Shimokawa H, Berry C. Treatment of coronary microvascular dysfunction. Cardiovasc Res. 2020;116(4):856-870.
• 9. Rentrop KP, Thornton JC, Feit F, Van Buskirk M. Determinants and protec- tive potential of coronary arterial collaterals as assessed by an angioplasty model. Am J Cardiol. 1988;61810):677-684.
• 10. Nombela-Franco L, Iannaccone M, Anguera I, et al. Impact of Chronic Total Coronary Occlusion on Recurrence of Ventricular Arrhythmias in Ischemic Secondary Prevention Implantable Cardioverter Defibrillator Recipients (VACTO Secondary Study): Insights From Coronary Angiogram and Electrogram Analysis. JACC Cardiovasc Interv. 2017;1089):879-888.
• 11. Seiler C. The human coronary collateral circulation. Eur J Clin Invest. 2010;40(5):465-476.
• 12. Van Belle E, Rivard A, Chen D, et al. Hypercholesterolemia attenuates angio- genesis but does not preclude augmentation by angio- genic cytokines. Circulation 1997;96(8):2667-2674.
• 13. Mancini GB, Henry GC, Macaya C, et al. Angiotensinconverting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coro- nary artery disease. The TREND (Trial on Reversing ENdothelial Dysfunction) Study. Circulation. 1996;94(3):258-265.
• 14. Miura S, Matsuo Y, Saku K. Transactivation of KDR/Flk-1 by the B2 receptor induces tube formation in human coronary endothelial cells. Hypertension. 2003;41(5):1118-1123.
• 15. Schieffer B, Wirger A, Meybrunn M, et al. Comparative effects of chronic angiotensin-converting enzyme inhibition and angiotensin II type 1 receptor blockade on cardiac remodeling after myocardial infarction in the rat. Circulation. 1994;89(5):2273-2282.
• 16. Kern MJ, Petru MA, Ferry DR, et al. Regional coronary vasoconstriction after combined betaadrenergic and calcium channel blockade in patients with coronary artery disease. J Am Coll Cardiol. 1985;5(6):1438-1450.
• 17. Bonnefoy E, Kirkorian G. La mortalité des syndromes coronariens aigus [Mortality of myocardial infarction]. Ann Cardiol Angeiol (Paris). 2011;60(6):311-316.