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[Coronary collateral vessels during the early period of acute myocardial infarction: their development]
1Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, Tokyo.
Insights
Coronary collateral circulation develops over time following acute myocardial infarction (AMI). Early intervention shows less developed collaterals, while later assessment reveals improved coronary collateral function in AMI patients.
Area of Science:
- Cardiology
- Vascular Biology
- Myocardial Infarction Research
Context:
- Acute myocardial infarction (AMI) involves the occlusion of a coronary artery, leading to myocardial damage.
- Coronary collateral circulation (CCC) represents an alternative blood supply to the ischemic myocardium.
- Understanding CCC development is crucial for predicting outcomes and guiding treatment strategies in AMI patients.
Purpose:
- To investigate the incidence and development of coronary collateral circulations in patients with acute myocardial infarction (AMI).
- To assess the relationship between the timing of angiography after AMI onset and the extent of collateral vessel development.
- To evaluate the influence of preinfarction angina on collateral circulation in AMI patients.
Summary:
- This study analyzed 165 AMI patients with persistent 100% infarct-related artery occlusion, categorized into six groups based on angiography timing (within 6 hours to >45 days post-AMI).
- Collateral vessel presence and development, scored from 0-3, increased significantly with delayed angiography. Mean collateral scores ranged from 0.9 in the earliest group to 2.2 in the latest.
- While preinfarction angina was associated with better collateral development, its duration did not correlate with the extent of coronary collaterals.
Impact:
- The findings highlight that coronary collateral circulation progressively develops over time after an acute myocardial infarction.
- This suggests a potential window for therapeutic interventions aimed at promoting collateral growth or function in AMI.
- The study provides valuable insights into the natural history of collateralization in AMI, aiding in risk stratification and treatment planning.
Abstract:
The aim of this study was to investigate the incidence and development of coronary collateral circulations in patients with acute myocardial infarction (AMI). We categorized 165 patients with persistent 100% occlusion of the infarct-related artery into 6 groups according to the time from the onset of AMI to angiography. Group I consisted of 55 patients evaluated within 6 hours after the onset of AMI; Group II, 28 patients, between 6 and 12 hours after the onset; Group III, 12 patients, between 12 and 24 hours after the onset; Group IV, 11 patients, between 2 and 13 days after infarction; Group V, 46 patients, between 14 and 44 days after infarction; and Group VI, 13 patients, more than 45 days after infarction. Collateral vessels were applied a numerical score between 0 and 3 according to the degree of opacification of the native vessel distal to the occlusion. In 58%, 79%, 67%, 73%, 89%, and 92%, patients of Groups I to VI had evidence of collateral vessels, respectively. Well-developed collaterals were observed in 24% of Group I compared with 50%, 58%, 55%, 73% and 69% of patients in Groups II to VI, respectively. The mean coronary collateral scores were 0.9 +/- 0.1, 1.4 +/- 0.2, 1.4 +/- 0.3, 1.6 +/- 0.4, 2.0 +/- 0.2 and 2.2 +/- 0.3 for Groups I to VI, respectively. Patients with preinfarction angina had more well-developed collateral circulations than did patients without it, however, there was no significant correlation between the duration of previous angina and extent of coronary collaterals.