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The Anatolian Journal of Cardiology Survival of patients with well-developed collaterals undergoing CABG or medical treatment: An observational case-controlled study [Anatol J Cardiol]
Anatol J Cardiol. 2012; 12(2): 97-101 | DOI: 10.5152/akd.2012.033

Survival of patients with well-developed collaterals undergoing CABG or medical treatment: An observational case-controlled study

Ersan Tatlı1, Meryem Aktoz2, Mehmet Akif Çakar3, Emir Doğan4, Mustafa Alkan4, Bilhan Özalp4
1Trakya Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, Edirne, Türkiye
2Department of Cardiology, Faculty of Medicine, Trakya University, Edirne-Turkey
3Department of Cardiology, Sakarya Education and Research Hospital, Sakarya University, Republic of Turkey Ministry of Health, Sakarya-Turkey
4From Clinics of Cardiology, Ada Tıp Hospital, Sakarya

Objective: The effects of coronary artery bypass grafting (CABG) on mortality have not been evaluated in patients with well-developed coronary collaterals. We investigated functional capacity, presence of angina, the occurrence of acute myocardial infarction, survival and mortality in patients with well-developed coronary collaterals both undergoing and refusing CABG. Methods: The study was designed as a retrospective observational case-controlled study. Seventy-eight patients undergoing coronary angiography were included in this study. They had critical occlusion in the proximal left anterior descending artery (LAD) with Rentrop-3 collateral circulation towards LAD, and to proceed with CABG has been suggested. The patients were divided in two groups; first group proceeding with CABG (n=40) and the second, rejecting the surgery (medical treatment group; n=38). The rates of survival, the incidence of angina pectoris and acute myocardial infarction as well as the functional capacities were evaluated in all patients. Survival rates were evaluated using Kaplan-Meier survival analysis. Results: No statistically significant difference was observed between the two groups regarding the baseline characteristics of patients, the presence of angina pectoris, the severity of angina pectoris according to CCS, the occurrence of acute myocardial infarction or stroke, and the functional capacity according to NYHA (p>0.05). Death due to cardiovascular reasons was observed in eight patients of CABG group and in five patients of medical treatment group (p=0.710). The 5-year survival rate was observed to be 80% in CABG group while it was observed to be 84% in the medical treatment group (p=0.730). Conclusion: There was no significant difference regarding the survival rates in patients with well-developed coronary collaterals proceeding with CABG or medical treatment.

Keywords: Coronary collateral circulation, coronary bypass surgery, survival analysis, prognosis

İyi gelişmiş kolaterali olan KABG ya da tıbbi tedavi alan hastalarda sağkalım: Gözlemsel vaka-kontrollü çalışma

Ersan Tatlı1, Meryem Aktoz2, Mehmet Akif Çakar3, Emir Doğan4, Mustafa Alkan4, Bilhan Özalp4
1Trakya Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı, Edirne, Türkiye
2Department of Cardiology, Faculty of Medicine, Trakya University, Edirne-Turkey
3Department of Cardiology, Sakarya Education and Research Hospital, Sakarya University, Republic of Turkey Ministry of Health, Sakarya-Turkey
4From Clinics of Cardiology, Ada Tıp Hospital, Sakarya

Amaç: Bugüne kadar, iyi gelişmiş koroner kolaterali olan hastalarda baypas cerrahisinin mortalite üzerine etkisi değerlendirilmedi. Biz iyi geliş- miş kolaterali olan, baypas olmuş ve baypas’ı reddeden hastalar arasında sağkalım, mortalite, fonksiyonel kapasite, angina varlığı ve akut miyokart enfarktüs gelişimini araştırdık. Yöntemler: Çalışma retrospektif, vaka-kontrollü gözlemsel bir çalışma olarak dizayn edildi. Koroner anjiyografi uygulanan, sol ön inen arter proksimalinden tam tıkalı olup, Rentrop-3 kolaterali olan ve baypas ameliyatı önerilen 78 hasta retrospektif olarak çalışmaya alındı. Hastalar baypas’ı kabul eden (Grup1, n=40) ve reddeden (Grup 2, n=38) hastalar olmak üzere iki gruba bölündü. Tüm hastalarda sağkalım, fonksiyonel kapasite, angina varlığı ve akut miyokart enfarktüs gelişimi araştırıldı. Sağkalım oranları Kaplan-Meier sağkalım analizi ile değerlendirildi. Bulgular: İki grup arasında hastaların temel özellikleri, angina varlığı ve şiddeti, fonksiyonel kapasite, akut miyokart enfarktüsü veya inme geli- şimi açısından istatistiksel olarak anlamlı farklılık yoktu. Kardiyovasküler sebeplere bağlı olarak ölüm Grup 1’de 8 hastada, Grup 2’de 5 hastada görüldü (p=0.710). Beş yıllık takip sonunda sağkalım oranı Grup 1’de %80 iken Grup 2’de %84 olarak izlendi (p=0.730). Sonuç: İyi gelişmiş kolaterali olan baypas’a giden ve baypas’ı reddeden hastalar arasında sağkalım açısından farklılık görülmedi.

Anahtar Kelimeler: Koroner kolateral dolaşım, koroner baypas cerrahisi, sağkalım analizi, prognoz

Ersan Tatlı, Meryem Aktoz, Mehmet Akif Çakar, Emir Doğan, Mustafa Alkan, Bilhan Özalp. Survival of patients with well-developed collaterals undergoing CABG or medical treatment: An observational case-controlled study. Anatol J Cardiol. 2012; 12(2): 97-101