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Updated: Mar 28, 2026
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction
Eun Kyoung Kim1, Jin-Ho Choi1, Young Bin Song1
1Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Insights
Good collateral blood flow in ST-segment elevation myocardial infarction (STEMI) patients significantly reduces infarct size and improves myocardial salvage. This finding highlights the protective role of collateral circulation in STEMI outcomes.
Area of Science:
- Cardiology
- Cardiovascular Research
- Interventional Cardiology
Background:
- The role of collateral circulation in ST-segment elevation myocardial infarction (STEMI) remains debated.
- Understanding collateral flow's impact on infarct size and myocardial salvage is crucial for STEMI management.
Purpose of the Study:
- To investigate the impact of collateral circulation on myocardial salvage and infarct size in STEMI patients.
- To assess the association between collateral blood flow and infarct size in STEMI.
Main Methods:
- Coronary angiography assessed initial collateral flow in 306 STEMI patients.
- Cardiac magnetic resonance imaging measured infarct size and myocardial salvage within one week post-revascularization.
Main Results:
- Good collaterals (Rentrop grade ≥ 2) were present in 22% of patients with preprocedural TIMI flow 0/1.
- Patients with good collaterals had significantly smaller infarct size (17.1% vs 21.8%) and area at risk (33.8% vs 38.8%).
- Good collateralization was associated with improved myocardial salvage index (50.9% vs 43.8%) and was an independent predictor of smaller infarct size.
Conclusions:
- Well-developed collateral circulation in STEMI patients is independently associated with reduced infarct burden.
- Effective collateralization improves myocardial salvage, potentially explaining lower mortality and morbidity in these patients.
- These findings underscore the importance of assessing and potentially enhancing collateral flow in STEMI treatment strategies.
Unlabelled:
Conflict persists regarding whether the presence of early collateral blood flow to the infarct-related artery has an effective role in reducing infarct size and improving myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI). We sought to investigate the impact of the collateral circulation on myocardial salvage and infarct size in STEMI patients.
Methods:
In 306 patients who were diagnosed with STEMI and underwent cardiac magnetic resonance within 1 week after revascularization, initial collateral flow to the infarct-related artery was assessed by coronary angiography. Using cardiac magnetic resonance imaging, myocardial infarct size and salvage were measured.
Results:
Among 247 patients with preprocedural Thrombolysis in Myocardial Infarction flow 0/1, 54 (22%) patients had good collaterals (Rentrop grade ≥ 2, Collateral Connection Score ≥ 2). Infarct size and area at risk were significantly smaller in patients with good collaterals than those with poor collaterals (infarct size: 17.1 ± 10.1 %LV vs 21.8 ± 10.5 %LV, P = .003, area at risk: 33.8 ± 16.8 %LV vs 38.8 ± 15.5 %LV, P = .039). There was a significant difference of myocardial salvage index between 2 groups (50.9% ± 15.0% vs 43.8% ± 18.5%, P = .005). Poor collateralization was an independent predictor for large infarct size (odd ratio 2.48 [1.28-4.80], P = .007).
Conclusions:
In patients with STEMI, the presence of well-developed collaterals to occluded coronary artery from the noninfarct vessel and its extent were independently associated with reduced infarct burden and improved myocardial salvage. Our results help explain why MI patients with well-developed collateralization have reduced mortality and morbidity.
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