Joëlle Elias1, Loes P C Hoebers1, Ivo M van Dongen1, Bimmer E P M Claessen1, José P S Henriques2. 1. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 2. Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: j.p.henriques@amc.uva.nl.
Abstract
OBJECTIVES: This study sought to compare long-term clinical outcome in ST-segment elevation myocardial infarction (STEMI) patients with a concomitant chronic total occlusion (CTO) with well-developed versus poorly developed collaterals toward the CTO. BACKGROUND: In STEMI patients, presence of a CTO is associated with increased morbidity and mortality. CTOs are often (partially) perfused by collateral vessels. Therefore, when the infarct-related artery (IRA) is the main donor vessel for the collateral blood supply of the CTO, infarct size may increase significantly. Well-developed collaterals to the infarct related vessel have been associated with improved clinical outcome after STEMI. However, the impact of well-developed collaterals toward a concomitant CTO in STEMI patients is unknown. METHODS: Consecutive STEMI patients with a CTO in a non-IRA presenting for primary percutaneous coronary intervention (PCI) were divided according to the presence of angiographic, well-developed (grade 2 to 3) or poorly developed collaterals (grade 0 to 1). RESULTS: Between 2000 and 2012 we included 413 STEMI patients with a single concomitant CTO. Well-developed collaterals to the CTO were present in 53%. Associated with poorly developed collaterals to the CTO were cardiogenic shock (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.11 to 3.07; p = 0.02), CTO located in the left circumflex artery (HR: 1.9; 95% CI: 1.00 to 3.43; p = 0.05), CTO diameter ≤2.5 mm (HR: 2.1; 95% CI: 1.07 to 4.12; p = 0.03), and CTO tapering (HR: 1.9; 95% CI: 1.21 to 2.85; p < 0.001). Patients with well-developed collaterals to the CTO had a better 5-year survival compared to those with poorly developed collaterals (74% vs. 63%; p = 0.01). The presence of well-developed collaterals to the CTO was independently associated with improved survival (HR: 1.5; 95% CI: 1.03 to 2.10; p = 0.04). CONCLUSIONS: In STEMI patients with a CTO in a non-IRA, the presence of well-developed collaterals to the CTO is associated with improved survival.
OBJECTIVES: This study sought to compare long-term clinical outcome in ST-segment elevation myocardial infarction (STEMI) patients with a concomitant chronic total occlusion (CTO) with well-developed versus poorly developed collaterals toward the CTO. BACKGROUND: In STEMI patients, presence of a CTO is associated with increased morbidity and mortality. CTOs are often (partially) perfused by collateral vessels. Therefore, when the infarct-related artery (IRA) is the main donor vessel for the collateral blood supply of the CTO, infarct size may increase significantly. Well-developed collaterals to the infarct related vessel have been associated with improved clinical outcome after STEMI. However, the impact of well-developed collaterals toward a concomitant CTO in STEMI patients is unknown. METHODS: Consecutive STEMI patients with a CTO in a non-IRA presenting for primary percutaneous coronary intervention (PCI) were divided according to the presence of angiographic, well-developed (grade 2 to 3) or poorly developed collaterals (grade 0 to 1). RESULTS: Between 2000 and 2012 we included 413 STEMI patients with a single concomitant CTO. Well-developed collaterals to the CTO were present in 53%. Associated with poorly developed collaterals to the CTO were cardiogenic shock (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.11 to 3.07; p = 0.02), CTO located in the left circumflex artery (HR: 1.9; 95% CI: 1.00 to 3.43; p = 0.05), CTO diameter ≤2.5 mm (HR: 2.1; 95% CI: 1.07 to 4.12; p = 0.03), and CTO tapering (HR: 1.9; 95% CI: 1.21 to 2.85; p < 0.001). Patients with well-developed collaterals to the CTO had a better 5-year survival compared to those with poorly developed collaterals (74% vs. 63%; p = 0.01). The presence of well-developed collaterals to the CTO was independently associated with improved survival (HR: 1.5; 95% CI: 1.03 to 2.10; p = 0.04). CONCLUSIONS: In STEMI patients with a CTO in a non-IRA, the presence of well-developed collaterals to the CTO is associated with improved survival.
Authors: Mohsen Afarideh; Xin Zhang; Christopher M Ferguson; James F Glockner; Amir Lerman; Stephen C Textor; Lilach O Lerman Journal: Hypertension Date: 2020-06-08 Impact factor: 10.190
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: Joëlle Elias; Ivo M van Dongen; Loes P Hoebers; Dagmar M Ouweneel; Bimmer E P M Claessen; Truls Råmunddal; Peep Laanmets; Erlend Eriksen; René J van der Schaaf; Dan Ioanes; Robin Nijveldt; Jan G Tijssen; Alexander Hirsch; José P S Henriques Journal: J Cardiovasc Magn Reson Date: 2017-07-19 Impact factor: 5.364
Authors: Ivo M van Dongen; Dilek Yilmaz; Joëlle Elias; Bimmer E P M Claessen; Ronak Delewi; Reinoud E Knops; Arthur A M Wilde; Lieselot van Erven; Martin J Schalij; José P S Henriques Journal: J Am Heart Assoc Date: 2018-05-02 Impact factor: 5.501