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Impact of collateralisation to a concomitant chronic total occlusion in patients with ST-elevation myocardial

Ivo M van Dongen1, Joëlle Elias1, K Gert van Houwelingen2

  • 1Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Open Heart
|July 31, 2018
PubMed

Insights

Well-developed coronary collaterals in ST-elevation myocardial infarction (STEMI) patients with chronic total occlusions (CTO) improve left ventricular ejection fraction but not clinical outcomes. Collateral status alone should not dictate CTO revascularization decisions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Myocardial Infarction Research

Background:

  • Coronary artery disease management, particularly in ST-elevation myocardial infarction (STEMI) with concomitant chronic total occlusions (CTO), remains complex.
  • The role of collateral circulation in influencing cardiac function and clinical outcomes in STEMI patients with CTO is not well-established.

Purpose of the Study:

  • To investigate the impact of well-developed versus poorly developed coronary collaterals on cardiac function in STEMI patients with CTO.
  • To evaluate whether the presence of good collaterals influences clinical outcomes in this patient population.

Main Methods:

  • Analysis of data from the EXPLORE trial, randomizing STEMI patients with CTO to CTO percutaneous coronary intervention (PCI) or no-CTO PCI.
  • Angiographic scoring of collateral grades (Rentrop classification) and measurement of left ventricular ejection fraction (LVEF) and end-diastolic volume (LVEDV) via cardiac MRI at 4 months.

Main Results:

  • Well-developed collaterals (Rentrop grades 2-3) were present in 54% of patients.
  • Patients with well-developed collaterals showed significantly higher LVEF (46.2% vs 42.1%, p=0.004) and a trend for lower LVEDV at 4 months compared to those with poorly developed collaterals.
  • No significant difference in scar burden or long-term clinical event rates was observed between groups.

Conclusions:

  • In STEMI patients with CTO, well-developed collaterals are associated with improved LVEF at 4 months.
  • This improvement in LVEF did not translate to better clinical outcomes.
  • Collateral status is an important factor but should not be the sole determinant for revascularization decisions in concomitant CTOs.
Abstract

Keywords:
cardiac functionchronic total occlusion (cto)coronary collateral circulationcoronary intervention (pci)stemi

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