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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Angiographically visible coronary artery collateral circulation improves prognosis in patients presenting with acute
Osama Alsanjari1, Tarak Chouari1, Timothy Williams1
1Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton, UK.
Insights
Coronary collaterals in ST-elevation myocardial infarction (STEMI) patients improve long-term survival. Early visible collaterals reduce the risk of cardiogenic shock, offering a significant prognostic benefit.
Area of Science:
- Cardiology
- Vascular Biology
Background:
- Coronary collaterals supply blood to occluded arteries, but their prognostic impact in acute myocardial infarction is unclear.
- Early collateralization may offer a survival benefit in ST-elevation myocardial infarction (STEMI).
Purpose of the Study:
- To investigate the prognostic significance of angiographically visible coronary collaterals in patients with acute ST-elevation myocardial infarction (STEMI).
Main Methods:
- Analysis of 2,542 STEMI patients undergoing immediate angiography (1999-2017) with TIMI 0/1 flow in the infarct-related artery.
- Assessment of in-hospital and long-term outcomes based on the presence or absence of visible coronary collaterals before intervention.
Main Results:
- 17% of STEMI patients exhibited visible collaterals, more common in the right coronary artery.
- Patients without collaterals had higher rates of cardiogenic shock (10.8%) and intra-aortic balloon pump use (5.4%).
- The presence of collaterals was associated with improved long-term survival (p < .01).
Conclusions:
- Angiographically visible collaterals are present in 17% of STEMI patients.
- Absence of collaterals correlates with increased risk of cardiogenic shock.
- Visible coronary collaterals at STEMI diagnosis indicate improved long-term survival.
Background:
Coronary collaterals are often seen supplying retrograde flow to an acutely occluded arterial territory. Whether this early collateralization offers prognostic benefit is not well established.
Methods:
We analyzed data from all patients presenting to our regional cardiac unit with acute ST-elevation myocardial infarction requiring immediate angiography (years 1999-2017). Data on all patients is entered prospectively into a bespoke tailored database prior to knowledge of patient outcome. Only patients with TIMI 0 or 1 flow in the infarct-related vessel were included in the analysis. In-hospital and long-term outcome were assessed according to the presence or absence of angiographically visible collateral flow prior to treatment of the occluded vessel.
Results:
Two thousand five hundred and forty-two patients were included in the analysis. 76% of these (n = 1944) had TIMI 0/1 flow at angiography. Angiographically-visible collateralization was seen in 17% (n = 322) and was more commonly observed in the right coronary artery (64%) than in the left anterior descending (25%) or Cx (6%). Cardiogenic shock (10.8%) and use of an intra-aortic balloon pump (5.4%) were more frequent in patients without coronary collateralisation (p = .04 and p = .02, respectively). The presence of collaterals improved long term survival (95% CI 11.4-18.7 months; p < .01).
Conclusion:
One-sixth of patients with STEMI have angiographically visible collaterals to the infarcted territory. Patients without collaterals are more likely to present in cardiogenic shock. The presence of angiographically visible collaterals at the time of STEMI is associated with an improved long-term survival.
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