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document
Effects of coronary sinus occlusion on myocardial ischaemia in humans : role of coronary collateral function . OBJECTIVE This study tested the hypotheses that intermittent coronary sinus occlusion ( iCSO ) reduces myocardial ischaemia , and that the amount of ischaemia reduction is related to coronary collateral function . DESIGN Prospective case-control study with intraindividual comparison of myocardial ischaemia during two 2-min coronary artery balloon occlusions with and without simultaneous iCSO by a balloon-tipped catheter . SETTING University Hospital . PATIENTS 35 patients with chronic stable coronary artery disease . INTERVENTION 2-min iCSO . MAIN OUTCOME MEASURES Myocardial ischaemia as assessed by intracoronary ( i.c . ) ECG ST shift at 2 min of coronary artery balloon occlusion . Collateral flow index ( CFI ) without iCSO , that is , the ratio between mean distal coronary occlusive ( Poccl ) and mean aortic pressure ( Pao ) both minus central venous pressure . RESULTS I.c . ECG ST segment shift ( elevation in all ) at the end of the procedure with iCSO versus without iCSO was 1.33±1.25 mV versus 1.85±1.45 mV , p < 0.0001 . Regression analysis showed that the degree of i.c . ECG ST shift reduction during iCSO was related to CFI , best fitting a Lorentzian function ( r ( 2 ) =0.61 ) . Ischaemia reduction with iCSO was greatest at a CFI of 0.05-0.20 , whereas in the low and high CFI range the effect of iCSO was absent . CONCLUSIONS ICSO reduces myocardial ischaemia in patients with chronic coronary artery disease . Ischaemia reduction by iCSO depends on coronary collateral function . A minimal degree of collateral function is necessary to render iCSO effective . ICSO can not manifest an effect when collateral function prevents ischaemia in the first place .
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Intervention_Physical
2-min iCSO .
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Intervention_Physical
intracoronary ( i.c . ) ECG ST shift at 2 min of coronary artery balloon occlusion .
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Outcome_Physical
myocardial ischaemia
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Outcome_Physical
ischaemia
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Outcome_Physical
Myocardial ischaemia
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Outcome_Physical
intracoronary ( i.c . ) ECG ST shift
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Outcome_Physical
Collateral flow index ( CFI ) without iCSO
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Outcome_Physical
ECG ST segment shift