Document Detail


The relationship of chronic angiotensin converting enzyme inhibitor use and coronary collateral vessel development.
MedLine Citation:
PMID:  17827815     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Angiotensin II induces various growth factors such as vascular endothelial growth factor, platelet-derived growth factor, and fibroblast growth factor, and recent studies suggest that the expression of these growth factors promotes collateral growth. We hypothesized that the blockage of angiotensin II production by ACE inhibitors might interfere with collateral development in patients with coronary occlusion. METHODS: The study group consisted of 187 patients (114 males, mean ages, 62 +/- 11 years) who had chronic (> 1 month) coronary occlusion (TIMI flow grade < or = 1) in one of 3 epicardial coronary arteries. Collaterals were graded using the Rentrop classification, and the patients were divided into 2 groups according to having good (grade 2 and 3) or poor (grade 0 and 1) collaterals (n = 127 and 60, respectively). Clinical and angiographic characteristics were compared in the 2 groups. RESULTS: ACE inhibitor use (52% versus 35%, P = 0.04) and the prevalence of diabetes mellitus (DM) (43% versus 27%, P = 0.02) was higher in patients with poor collaterals. Patients with poor collaterals had a higher frequency of circumflex artery (Cx) occlusion, worse wall motion, and lower ejection fraction. In multivariate analysis, ACE inhibitor use (OR: 2.4; 95% CI = 1.23-4.68, P = 0.01) and the occlusion of Cx (OR: 3.3, 95% CI; 1.33-8.12, P = 0.01) were found to be independent predictors for poor collateral development, whereas there was a trend for DM as a predictor for poor collaterals (OR: 1.9, 95% CI = 0.97-3.8, P = 0.06). CONCLUSION: The findings suggest that ACE inhibitor therapy may contribute to poor collateral development in patients with coronary occlusion.
Authors:
Timucin Altin; Mustafa Kilickap; Eralp Tutar; Sibel Turhan; Yusuf Atmaca; Sadi Gulec; Dervis Oral; Cetin Erol
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International heart journal     Volume:  48     ISSN:  1349-2365     ISO Abbreviation:  -     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-09-10     Completed Date:  2008-04-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101244240     Medline TA:  Int Heart J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  435-42     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey.
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MeSH Terms
Descriptor/Qualifier:
Angiotensin-Converting Enzyme Inhibitors / adverse effects*
Collateral Circulation / drug effects*
Coronary Angiography
Coronary Disease / drug therapy,  physiopathology*
Coronary Vessels / drug effects*
Diabetes Complications
Female
Humans
Male
Middle Aged
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors

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