Eun Kyoung Kim1, Jin-Ho Choi2, Young Bin Song1, Joo-Yong Hahn1, Sung-A Chang1, Sung-Ji Park1, Sang-Chol Lee1, Seung-Hyuk Choi1, Yeon Hyeon Choe3, Seung Woo Park1, Hyeon-Cheol Gwon1. 1. Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. 2. Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jhchoimd@gmail.com. 3. Division of Radiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Abstract
UNLABELLED: Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients. METHODS: In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured. RESULTS: Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥ 2, Collateral Connection Score ≥ 2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1 ± 10.1 %LV vs 21.8 ± 10.5 %LV, P = .003, area at risk: 33.8 ± 16.8 %LV vs 38.8 ± 15.5 %LV, P = .039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P = .005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P = .007). CONCLUSIONS: In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MI patients with well-developed collateralization have reduced mortality and morbidity.
UNLABELLED: Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients. METHODS: In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured. RESULTS: Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥ 2, Collateral Connection Score ≥ 2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1 ± 10.1 %LV vs 21.8 ± 10.5 %LV, P = .003, area at risk: 33.8 ± 16.8 %LV vs 38.8 ± 15.5 %LV, P = .039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P = .005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P = .007). CONCLUSIONS: In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MIpatients with well-developed collateralization have reduced mortality and morbidity.
Authors: Ivo M van Dongen; Joëlle Elias; K Gert van Houwelingen; Pierfrancesco Agostoni; Bimmer E P M Claessen; Loes P Hoebers; Dagmar M Ouweneel; Esther M Scheunhage; Ronak Delewi; Jan J Piek; Truls Råmunddal; Peep Laanmets; Erlend Eriksen; Matthijs Bax; Maarten J Suttorp; René J van der Schaaf; Jan G P Tijssen; José P S Henriques Journal: Open Heart Date: 2018-07-16
Authors: Nora Gatzke; Nadija Güc; Philipp Hillmeister; André Dülsner; Ferdinand Le Noble; Eva Elina Buschmann; Maja Ingwersen; Peter Bramlage; Ivo R Buschmann Journal: Open Heart Date: 2018-12-04
Authors: A Gutiérrez-Barrios; L Gheorghe; S Camacho-Freire; F Valencia-Serrano; D Cañadas-Pruaño; G Calle-Pérez; I Alarcón de la Lastra; E Silva; D García-Molinero; A Agarrado-Luna; R Zayas-Ruedas; R Vázquez-García; A Serra Journal: J Interv Cardiol Date: 2020-07-27 Impact factor: 2.279