Prognostic implications of the rapid recruitment of coronary collaterals during ST elevation myocardial infarction (STEM
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Prognostic implications of the rapid recruitment of coronary collaterals during ST elevation myocardial infarction (STEMI): a meta‑analysis of over 14,000 patients Usaid K. Allahwala1,2 · Daniel Nour1 · Osama Alsanjari3 · Kunwardeep Bhatia1 · Vinayak Nagaraja4 · Jaikirshan J. Khatri4 · James Cockburn3 · David Hildick‑Smith3 · Yasuhiko Sakata5 · Michael Ward1 · James C. Weaver2,6 · Ravinay Bhindi1,2 Accepted: 11 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Acute coronary collateralisation of an infarct-related arterial (IRA) territory may be identified during angiography for ST elevation myocardial infarction (STEMI). Whether the presence or absence of these collaterals affects outcomes remains uncertain. A search of EMBASE, MEDLINE and Cochrane Library, using the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines was conducted to identify studies which reported on the association between coronary collaterals and in-hospital and longer term mortality, left ventricular ejection fraction (LVEF), risk of repeat acute myocardial infarction (AMI) and repeat revascularisation. Patients with Rentrop grade 0 or 1 were defined as poor collaterals whilst those with Rentrop grade two or three were defined as those with robust collaterals. Studies were eligible if they included patients ≥ 18 years of age who had immediate coronary angiography for STEMI. Included studies were observational which recorded the degree of collateral blood flow to the IRA. Two investigators reviewed all citations using a predefined protocol with final consensus for all studies, the data from which was then independently entered to ensure fidelity of results. Inverse variance random effects model for the meta-analysis along with risk of bias assessment was performed. 20 studies with a total of 14,608 patients were identified and included in the analysis. Patients with robust collaterals had lower mortality (OR 0.55, 95% CI 0.48–0.64), both in-hospital (OR 0.47, 95% CI 0.35–0.63) and longer term (OR 0.58, 95% CI 0.46–0.75). Patients with robust collaterals also had a higher mean LVEF (SMD 0.23, 95% CI 0.10–0.37). There was no difference in the rates of AMI or repeat revascularisation between patients with robust or poor collaterals. The presence of robust collaterals during STEMI is associated with reduced in-hospital and longer term mortality and improved left ventricular function. These findings have implications for prognostication and identifying patients who require close monitoring following STEMI. Keywords Coronary collaterals · Rentrop · STEMI · Collateral
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02282-6) contains supplementary material, which is available to authorized users. * Usaid K. Allahwala [email protected] 1
Department of Cardiology, Royal North Shore Hospital, Reserve Rd, St. Leonards, Sydney 2065, Australia
2
The University of Sydney, Sydney, Australia
3
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