Angiographically visible coronary artery collateral circulation improves prognosis in patients presenting with acute ST segment‐elevation myocardial infarction

Background Coronary collaterals are often seen supplying retrograde flow to an acutely occluded arterial territory. Whether this early collateralization offers prognostic benefit is not well established. Methods We analyzed data from all patients presenting to our regional cardiac unit with acute ST...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2020-09, Vol.96 (3), p.528-533
Main Authors: Alsanjari, Osama, Chouari, Tarak, Williams, Timothy, Myat, Aung, Sambu, Nalyaka, Blows, Lucy, Cockburn, James, Belder, Adam, Hildick‐Smith, David
Format: Article
Language:English
Subjects:
Aged
Angiography
Aorta
Collateral Circulation
Coronary Angiography
Coronary artery
Coronary Circulation
Coronary vessels
Databases, Factual
Female
Heart attacks
Humans
Male
Medical imaging
Medical prognosis
Middle Aged
Myocardial infarction
Patients
Percutaneous Coronary Intervention
Predictive Value of Tests
Risk Factors
Shock, Cardiogenic - diagnosis
Shock, Cardiogenic - mortality
Shock, Cardiogenic - physiopathology
Shock, Cardiogenic - therapy
ST Elevation Myocardial Infarction - diagnostic imaging
ST Elevation Myocardial Infarction - mortality
ST Elevation Myocardial Infarction - physiopathology
ST Elevation Myocardial Infarction - therapy
Survival
Territory
Time Factors
Treatment Outcome
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Summary:Background Coronary collaterals are often seen supplying retrograde flow to an acutely occluded arterial territory. Whether this early collateralization offers prognostic benefit is not well established. Methods We analyzed data from all patients presenting to our regional cardiac unit with acute ST‐elevation myocardial infarction requiring immediate angiography (years 1999–2017). Data on all patients is entered prospectively into a bespoke tailored database prior to knowledge of patient outcome. Only patients with TIMI 0 or 1 flow in the infarct‐related vessel were included in the analysis. In‐hospital and long‐term outcome were assessed according to the presence or absence of angiographically visible collateral flow prior to treatment of the occluded vessel. Results Two thousand five hundred and forty‐two patients were included in the analysis. 76% of these (n = 1944) had TIMI 0/1 flow at angiography. Angiographically‐visible collateralization was seen in 17% (n = 322) and was more commonly observed in the right coronary artery (64%) than in the left anterior descending (25%) or Cx (6%). Cardiogenic shock (10.8%) and use of an intra‐aortic balloon pump (5.4%) were more frequent in patients without coronary collateralisation (p = .04 and p = .02, respectively). The presence of collaterals improved long term survival (95% CI 11.4–18.7 months; p
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.28532