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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Impact of Collateral Circulation on Survival in ST-Segment Elevation Myocardial Infarction Patients Undergoing
Joëlle Elias1, Loes P C Hoebers1, Ivo M van Dongen1
1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Insights
In ST-segment elevation myocardial infarction (STEMI) patients with chronic total occlusion (CTO), well-developed collateral circulation to the CTO is linked to improved long-term survival. Poor collaterals indicate higher risks for adverse events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Chronic total occlusions (CTOs) in ST-segment elevation myocardial infarction (STEMI) patients increase morbidity and mortality.
- Collateral vessels can perfuse CTOs, potentially influencing infarct size and clinical outcomes.
- The specific impact of well-developed collaterals to a concomitant CTO in STEMI patients remains unclear.
Purpose of the Study:
- To compare long-term clinical outcomes in STEMI patients with a concomitant CTO.
- To investigate the influence of collateral development (well-developed vs. poorly developed) towards the CTO on patient survival.
- To identify factors associated with poorly developed collaterals in this patient cohort.
Main Methods:
- A cohort of 413 STEMI patients with a single non-infarct-related artery (non-IRA) CTO was analyzed.
- Patients were categorized based on angiographic assessment of collateral development to the CTO (grade 2-3 for well-developed, 0-1 for poorly developed).
- Long-term clinical outcomes, including 5-year survival, were compared between the two groups.
Main Results:
- 53% of patients had well-developed collaterals to the CTO.
- Poorly developed collaterals were associated with cardiogenic shock, CTO location in the left circumflex artery, smaller CTO diameter (≤2.5 mm), and CTO tapering.
- Patients with well-developed collaterals demonstrated significantly better 5-year survival (74% vs. 63%, p=0.01).
Conclusions:
- Well-developed collateral circulation to a non-IRA CTO in STEMI patients is associated with improved long-term survival.
- The presence of well-developed collaterals independently predicts better survival outcomes.
- Identifying collateral status is crucial for risk stratification and management of STEMI patients with CTO.
Objectives:
This study sought to compare long-term clinical outcome in ST-segment elevation myocardial infarction (STEMI) patients with a concomitant chronic total occlusion (CTO) with well-developed versus poorly developed collaterals toward the CTO.
Background:
In STEMI patients, presence of a CTO is associated with increased morbidity and mortality. CTOs are often (partially) perfused by collateral vessels. Therefore, when the infarct-related artery (IRA) is the main donor vessel for the collateral blood supply of the CTO, infarct size may increase significantly. Well-developed collaterals to the infarct related vessel have been associated with improved clinical outcome after STEMI. However, the impact of well-developed collaterals toward a concomitant CTO in STEMI patients is unknown.
Methods:
Consecutive STEMI patients with a CTO in a non-IRA presenting for primary percutaneous coronary intervention (PCI) were divided according to the presence of angiographic, well-developed (grade 2 to 3) or poorly developed collaterals (grade 0 to 1).
Results:
Between 2000 and 2012 we included 413 STEMI patients with a single concomitant CTO. Well-developed collaterals to the CTO were present in 53%. Associated with poorly developed collaterals to the CTO were cardiogenic shock (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.11 to 3.07; p = 0.02), CTO located in the left circumflex artery (HR: 1.9; 95% CI: 1.00 to 3.43; p = 0.05), CTO diameter ≤2.5 mm (HR: 2.1; 95% CI: 1.07 to 4.12; p = 0.03), and CTO tapering (HR: 1.9; 95% CI: 1.21 to 2.85; p < 0.001). Patients with well-developed collaterals to the CTO had a better 5-year survival compared to those with poorly developed collaterals (74% vs. 63%; p = 0.01). The presence of well-developed collaterals to the CTO was independently associated with improved survival (HR: 1.5; 95% CI: 1.03 to 2.10; p = 0.04).
Conclusions:
In STEMI patients with a CTO in a non-IRA, the presence of well-developed collaterals to the CTO is associated with improved survival.
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