Hubungan Beberapa Faktor Klinis dan Pengobatan Penyakit Arteri Koroner dengan Pembentukan dan Gradasi Kolateral Arteri Koroner
Abstract
Penyakit arteri koroner (PAK) ditandai lesi aterosklerosis yang menyebabkan penurunan suplai oksigen ke miokardium. Sebagian pasien PAK membentuk pembuluh kolateral yang menambah suplai darah ke miokardium. Pembentukan kolateral didasari proses angiogenesis dan dipengaruhi oleh berbagai faktor. Aspirin telah digunakan sebagai pencegahan angiogenesis. Penelitian ini bertujuan mencari pengaruh faktor klinis dan pengobatan terhadap pembentukan kolateral koroner. Penelitian ini menggunakan metode potong lintang pada pasien PAK yang dilakukan angiografi koroner. Klasifikasi kolateral koroner dinilai menggunakan kriteria Rentrop. Subjek penelitian dibagi menjadi kolateral baik dan kolateral buruk, ditentukan berdasar atas penilaian intervensionis. Faktor yang dianalisis adalah keluhan angina, obat-obatan, lesi stenosis, dan faktor risiko kardiovaskular. Analisis statistik menggunakan korelasi Spearman dan regresi logistik. Sebanyak 382 pasien diikutsertakan dalam penelitian. Seluruh subjek penelitian memiliki stenosis koroner di atas 80% pada salah satu arteri koroner. Analisis kolateral koroner mendapatkan 164 pasien kolateral baik dan 158 orang kolateral buruk. Secara bivariat, faktor-faktor yang berpengaruh pada pembentukan kolateral koroner yang buruk adalah: penggunaan inhibitor ACE (p=0,048), penggunaan aspirin (p=0,047), oklusi pada pembuluh left circumflex (p=0,032), tidak ada keluhan angina (p=0,036), dan diabetes (p=0,047). Regresi logistik tidak menunjukkan kemaknaan dari faktor-faktor diatas terhadap pembentukan kolateral koroner (p=0,088). Penelitian ini menyimpulkan bahwa aspirin, inhibitor ACE, oklusi pembuluh left circumflex, tidak ada keluhan angina dan riwayat diabetes memiliki potensi untuk menghambat pembentukan kolateral koroner. [MKB. 2017;49(4):274–80]
Kata kunci: Faktor klinis, kolateral koroner, penyakit arteri koroner
Relationship between Several Clinical and Treatment Factors in Cad Patients in Coronary Collateral Development and Gradation
Coronary artery disease (CAD) involves atherosclerotic plaques that caused reduction of myocardial oxygen supply. Some CAD patients develop collaterals which augment myocardial blood circulation. Angiogenesis is a precursor for collateral development and influenced by multiple factors. Aspirin has been used as an angiogenesis inhibitor. This study was intended to elucidate clinical and treatment factors that may affect collateral development. This study employed cross-sectional methodology. Subjects were CAD patients who underwent coronary angiography. Grading of coronary collaterals was classified using Rentrop criteria. Subjects were categorized into poor collaterals and good collaterals, determined by an interventionist. Factors analyzed were anginal symptoms, medications, stenotic lesions, and cardiovascular risk factors. Data were examined using Pearson or Spearman correlation and logistic regression. A total of 382 patients were selected. All subjects had 80% or more stenotic lesions in one or more coronary arteries. There were 164 patients assigned as good collaterals and 158 patients was assigned as poor collaterals. Factors that hampered collateral development were: ACE (p=0.048) and aspirin (p=0.047) use, occlusion of left circumflex artery (p=0.032), no anginal symptoms (p=0.036) and diabetics (p=0,047). None of these factors was statistically significant in logistic regression (p=0.088). The study concluded that aspirin has a potential to diminish coronary collateral development. [MKB. 2017;49(4):274–80]
Key words: Clinical factors, coronary artery disease, coronary collaterals
Keywords
Full Text:
PDFReferences
Fujita M, Sasayama S. Reappraisal of functional importance of coronary collateral circulation. Cardiology. 2010;117(4):246–52.
Karrowni W, El Accaoui RN, Chatterjee K. Coronary collateral circulation: Its relevance. Catheter Cardiovasc Interv. 2013;82(6):915–28.
Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, Bugiardini R, dkk. ESC guidelines on the management of stable coronary artery disease: the task force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013;34(38):2949–3003
Lee CS, McNamara D, O’Morain CA. Aspirin as a chemoprevention agent for colorectal cancer. Curr Drug Metab. 2012;13(9):1313–22.
Ma C, Wang Q, Man Y, Kemmner W. Cardiovascular medications in angiogenesis-- how to avoid the sting in the tail. Int J Cancer. 2012;15(6):1249–59
Meier P, Lansky AJ, Fahy M, Xu K, White HD, Bertrand ME, dkk. The impact of the coronary collateral circulation on outcomes in patients with acute coronary syndromes: results from the ACUITY trial. Heart. 2014;100(8):647–512.
Berry C, Balachandran K, L’Allier L, Lesperance J, Bonan R, Oldroyd KG. Importance of collateral circulation in coronary heart disease. Eur Heart J. 2007;28(3):278–91
Holmes CE, Jasielec J, Levis JE, Skelly J, Muss HB. Initiation of aspirin therapy modulates angiogenic protein levels in women with breast cancer receiving tamoxifen therapy. Clin Translational Sci. 2013;6(5):386-90.
Schinkel AF, Staub D, Ten Kate GL, van den Oord SC, Ten Cate FJ, Sijbrands EJ, dkk. More on advances in angiogenesis and inflammation in atherosclerosis. Thromb Haemost. 2011;105(5):920–1.
Etulain J, Fondevila C, Negrotto S, Schattner M. Platelet-mediated angiogenesis is independent of VEGF and fully inhibited by aspirin. Brit J Pharmacol. 2013;170(2):255–65.
DOI: https://doi.org/10.15395/mkb.v49n4.1199
Article Metrics
Abstract view : 993 timesPDF - 743 times
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
MKB is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
View My Stats