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Original article
Clinical parameters associated with collateral development in patients with chronic total coronary occlusion
  1. N W van der Hoeven1,
  2. P F Teunissen1,
  3. G S Werner2,
  4. R Delewi3,
  5. S H Schirmer4,
  6. T Traupe5,
  7. A M van der Laan3,
  8. J G Tijssen3,
  9. J J Piek3,
  10. C Seiler5,
  11. N van Royen1
  1. 1Department of Cardiology, VU University Medical Center, Amsterdam, North-Holland, The Netherlands
  2. 2Department of Cardiology, Klinikum Darmstadt, Darmstadt, Germany
  3. 3Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  4. 4Department of Cardiology, Klinik für Innere Medizin III, Universität des Saarlandes, Homburg/Saar, Germany
  5. 5Department of Cardiology, Bern University Hospital, Bern, Switzerland
  1. Correspondence to N W van der Hoeven, Department of Cardiology, VU University Medical Center, 1081 HV Amsterdam, The Netherlands; nw.vanderhoeven{at}


Objective Well-developed collaterals provide survival benefit in patients with obstructive coronary artery disease (CAD). Therefore, in this study we sought to determine which clinical variables are associated with arteriogenesis.

Design Clinical and laboratory variables were collected before percutaneous coronary intervention. Multivariate analysis was performed to determine which variables are associated with the collateral flow index (CFI).

Patients Data from 295 chronic total occlusion (CTO) patients (Bern, Switzerland, Amsterdam, the Netherlands and Jena, Germany) were pooled. In earlier studies, patients had varying degrees of stenosis. Therefore, different stages of development of the collaterals were used. In our study, a unique group of patients with CTO was analysed.

Interventions Instead of angiography used earlier, we used a more accurate method to determine CFI using intracoronary pressure measurements. CFI was calculated from the occlusive pressure distal of the coronary lesion, the aortic pressure and central venous pressure.

Results The mean CFI was 0.39±0.14. After multivariate analysis, β blockers, hypertension and angina pectoris duration were positively associated with CFI (B: correlation coefficient β=0.07, SE=0.03, p=0.02, B=0.040, SE=0.02, p=0.042 and B=0.001, SE=0.000, p=0.02). Furthermore also after multivariate analysis, high serum leucocytes, prior myocardial infarction and high diastolic blood pressure were negatively associated with CFI (B=−0.01, SE=0.005, p=0.03, B=−0.04, SE=0.02, p=0.03 and B=−0.002, SE=0.001, p=0.011).

Conclusions In this unique cohort, high serum leucocytes and high diastolic blood pressure are associated with poorly developed collaterals. Interestingly, the use of β blockers is associated with well-developed collaterals, shedding new light on the potential action mode of this drug in patients with CAD.


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