Coronary collaterals in patients with ST-elevation myocardial infarction presenting late after symptom onset
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ORIGINAL PAPER
Coronary collaterals in patients with ST‑elevation myocardial infarction presenting late after symptom onset Anne Freund1,2,3 · Thomas Stiermaier2,4 · Suzanne de Waha‑Thiele2,4 · Ingo Eitel2,4 · Sandra Schock1 · Philipp Lurz1 · Holger Thiele1,3 · Steffen Desch1,2,3,4 Received: 14 January 2020 / Accepted: 2 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The role of coronary collaterals in ST-elevation myocardial infarction (STEMI) remains controversial. So far, studies examining the effect of collaterals on outcome mainly focused on patients presenting early after symptom onset. We sought to investigate the prognostic influence of coronary collateralization in patients presenting with prolonged ischemia late after symptom onset. Methods and results The study is a subanalysis of a randomized trial addressing thrombus aspiration in STEMI patients presenting between 12 and 48 h after symptom onset with a follow-up period of a minimum of 4 years. A total of 95 patients with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 or 1 prior to percutaneous coronary intervention (PCI) were included in the analysis. Of these, 62 patients (65%) had none or poor coronary collateralization according to the Rentrop classification (Rentrop grade 0 or 1) compared to 33 (35%) with well-developed collateralization (Rentrop grade 2 or 3). In comparison, patients with well-developed collateralization had a smaller area of microvascular obstruction (2.1 ± 3.8 vs. 4.5 ± 4.9% of left ventriclular mass (%LV), p = 0.03) and infarct size (27.9 ± 11.7 vs. 34.8 ± 17.2% LV, p = 0.047) on magnetic resonance imaging. Further, mortality at 4-years follow-up was lower (6% Rentrop grade 2 or 3 vs. 25% Rentrop grade 0 or 1, p = 0.02). Poor collateralization was an independent predictor of long-term mortality on multivariate Cox regression analyses in addition to cardiogenic shock and unsuccessful PCI during the index procedure. Conclusion Sufficient coronary collateralization has a positive impact on microvascular obstruction, infarct size and longterm mortality in STEMI patients presenting between 12 and 48 h after symptom onset. Keywords Collaterals · Rentrop · ST-elevation myocardial infarction · Late presenting · Clinical outcome
Introduction Coronary collaterals in humans are frequent. In vivo tests were able to show that up to 20–25% of patients without coronary artery disease (CAD) do not develop angina or signs of myocardial ischemia on electrocardiogram (ECG) * Anne Freund [email protected]‑leipzig.de 1
Heart Center Leipzig, Department of Internal Medicine/ Cardiology, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
2
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
3
Leipzig Heart Institute, Leipzig, Germany
4
University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
in case of balloon occlusion of a coronary artery due to collateral function [1]. In
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