Long-term clinical impact of coronary-collateral vessels after acute myocardial infarction
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Pedro Monteiro1, Alexandre Antunes, Lino M Gonçalves
1Serviço de Cardiologia, Hospitais da Universidade de Coimbra, Coimbra.
Insights
The presence of coronary collateral vessels after acute myocardial infarction (AMI) is linked to better long-term patient outcomes. These vessels improve clinical results, reducing adverse events and improving functional class post-AMI.
Area of Science:
- Cardiology
- Vascular Biology
- Clinical Medicine
Background:
- Coronary collateral vessels play a recognized role in the acute phase of myocardial infarction (AMI).
- However, their influence on the long-term clinical prognosis of patients post-AMI remains incompletely understood.
Purpose of the Study:
- To investigate the impact of well-developed coronary collateral vessels on the long-term clinical outcomes of patients following an AMI.
- To assess the association between collateral circulation and major adverse cardiovascular events and functional status.
Main Methods:
- A cohort of 70 patients post-AMI underwent coronary angiography for collateral vessel assessment.
- Patients were categorized into two groups based on the presence (n=35) or absence (n=35) of well-developed collateral vessels.
- Clinical evolution was tracked for a mean follow-up of 15.6 months.
Main Results:
- The group with collaterals exhibited more severe coronary artery disease, including higher rates of significant lesions in the left circumflex and right coronary arteries.
- Despite similar baseline characteristics and left ventricular function, patients with collaterals experienced significantly fewer adverse events (40% vs. 69%) post-discharge.
- The collateral group also demonstrated a lower Canadian Cardiovascular Society (CCS) functional class at follow-up (1.26 vs. 1.73).
Conclusions:
- The presence of coronary collateral vessels following acute myocardial infarction is associated with improved long-term clinical outcomes.
- Collateral circulation may serve as a protective factor, mitigating adverse events and enhancing functional recovery in post-AMI patients.
Background:
The positive impact of coronary collateral vessels in the acute phase of myocardial infarction (AMI) is already well established. However, their impact on longterm clinical outcome of these patients is still unclear.
Aim:
To study the impact of the presence of well established coronary collateral vessels on long-term clinical outcome of post-AMI patients.
Population And Methods:
We analyzed the clinical evolution (mean follow-up time of 15.66.8 months) of 70 patients who underwent coronary angiography shortly after AMI. According to the angiogram, the patients were divided into 2 groups: those with well developed coronary collateral vessels (n = 35) and those who did not show developed collateral circulation (n = 35).
Results:
Both groups had similar baseline characteristics (regarding demography, coronary artery disease risk factors and predischarge evolution). The group with collaterals had more severe coronary disease compared with the group without collaterals (2.31 +/- 0.61 vs. 1.57 +/- 0.7; p = 0.00001). Moreover, this group more frequently showed significant lesions on the left anterior descending artery (83% vs. 74%; p = NS), left circumflex (71% vs. 43%; p = 0.02) and right coronary arteries (74% vs. 40%; p = 0.003). Primary percutaneous coronary intervention was more often performed in patients without coronary collateral vessels (58% vs. 30%; p = 0.02). Left ventricular function was similar in both groups. During follow-up, both groups underwent similar levels of revascularization by percutaneous coronary intervention and/or coronary artery bypass graft (70% vs. 76%; p = NS). Despite these characteristics, the group with collaterals showed a significantly better clinical outcome, with fewer events (combined endpoint of unstable angina, non-fatal AMI, heart failure and death) after hospital discharge (40% vs. 69%; p = 0.02) and a lower CCS functional class at the end of follow-up (1.26 +/- 0.63 vs. 1.730.71; p = 0.03).
Conclusion:
After acute myocardial infarction, the presence of collateral vessels is associated with a better long-term clinical outcome.
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