Collateral filling efficiency of comorbid chronic total occlusion segment on short-term mortality in ST-elevation
Toshiharu Fujii1, Masataka Nakano1, Yohei Ohno1
1Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Insights
Poor collateral filling in chronic total occlusion (CTO) segments predicts higher short-term mortality in ST-elevation myocardial infarction (STEMI) patients. Assessing collateral flow via Rentrop grade is crucial for predicting death risk after primary percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Collateral circulation in chronic total occlusion (CTO) segments influences hemodynamic stability during primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).
- The prognostic value of collateral filling in CTO segments for mortality risk remains uncertain.
- This study investigates the association between collateral filling and short-term mortality in STEMI patients with comorbid CTO lesions.
Purpose of the Study:
- To evaluate the relationship between collateral filling of CTO segments and 30-day all-cause mortality in STEMI patients undergoing primary PCI.
- To determine if Rentrop grade and the origin of collateral donor arteries predict mortality.
- To identify independent predictors of mortality in this patient cohort.
Main Methods:
- Retrospective analysis of 829 STEMI patients undergoing primary PCI, identifying 74 with CTO.
- Collateral filling assessed by Rentrop grade (0-3) on initial angiogram.
- Origin of collateral donor artery (infarct-related artery vs. non-infarct-related artery) evaluated on final angiogram.
- Correlation between collateral status and 30-day all-cause mortality analyzed.
Main Results:
- 30-day mortality rates were 4.5% (single-vessel disease), 18.3% (multi-vessel disease without CTO), and 25.7% (multi-vessel disease with CTO).
- Mortality in CTO patients decreased with increasing Rentrop grade (80.0% for grade 0 to 5.0% for grade 3).
- Infarct-related artery origin was associated with significantly higher mortality (50.0% vs. 12.5%).
- Low Rentrop grade (0 or 1) independently predicted 30-day death (HR 3.28).
Conclusions:
- Poor collateral filling of CTO segments, indicated by low Rentrop grade, is an independent angiographic predictor of 30-day mortality in STEMI patients with CTO.
- Rentrop grade assessment provides valuable prognostic information for risk stratification in these complex cases.
- Optimizing collateral flow or intervention strategies may be critical for improving outcomes.
Background:
Collateral filling of chronic total occlusion (CTO) segments is considered to affect hemodynamic stability in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) with CTO, however its value as a prognostic indicator for mortality is uncertain. The present study examined the relationship between collateral filling of CTO segments and short-term mortality in patients with STEMI with a comorbid CTO lesion.
Methods:
Among 829 STEMI patients who underwent primary PCI, 74 patients with CTO were identified. Collateral filling of their CTO segment was assessed by Rentrop grade (0; n=10, 1; n=13, 2; n=31, 3; n=20) in their initial angiogram and whether the origin of the feeding collateral donor artery was infarct-related artery (IRA) was evaluated using their final angiogram in primary PCI; IRA (n=26) and non-IRA group (n=48). The relationship between these classifications and 30-day all-cause mortality was examined retrospectively.
Results:
The 30-day mortalities were 4.5% in single-vessel disease, 18.3% in multi-vessel disease (MVD) without CTO and 25.7% in MVD with CTO. Mortality of MVD with CTO reduced with increasing Rentrop grade from 0 to 3 (80.0%, 30.8%, 19.4%, and 5.0%, respectively). IRA was associated with a significant higher mortality than those of non-IRA (50.0% vs. 12.5%, P=0.0004). Low Rentrop grade 0 or 1 was extracted as an independent predictor of 30-day death (HR 3.28, 95% CI 1.20-9.96, P=0.0203).
Conclusions:
Poor collateral filling of the CTO segment assessed by Rentrop grade was an independent angiographic predictor for 30-day death in patients with STEMI combined with CTO.
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