Relation of collateral circulation with reciprocal changes in patients with acute ST-elevation myocardial infarction
Hanan Ibrahim Radwan1, Ahmed Abd Elmoneim Mohamed2, Ahmed Shafea Ammar1
1Faculty of Medicine, Zagazig University, Cardiovascular Department, Egypt.
Insights
Reciprocal ST-segment depression in acute myocardial infarction is not linked to collateral circulation. Instead, it may arise from widespread ischemia and electrical changes in patients with multi-vessel coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Reciprocal ST-segment depression (RC) frequently accompanies ST-elevation myocardial infarction (STEMI).
- The role of collateral circulation in RC development remains unclear.
- This study investigates the relationship between collateral circulation and RC in STEMI patients undergoing primary percutaneous intervention (PPCI).
Purpose of the Study:
- To determine the association between collateral circulation and reciprocal ST-segment depression in STEMI patients treated with PPCI.
- To identify predictors of reciprocal ST-segment depression in this patient cohort.
Main Methods:
- 112 STEMI patients undergoing PPCI were analyzed.
- Patients were categorized into two groups: with RC (n=66) and without RC (n=46).
- Data collected included ECG, cardiac biomarkers (CKMB), echocardiography (LVEF), and coronary angiography to assess culprit artery, vessel disease, and collateral circulation.
Main Results:
- Patients with RC showed shorter door-to-balloon times, more inferior infarctions, higher CKMB, increased left ventricular dimensions, lower LVEF, and a higher prevalence of multi-vessel disease and RCA as the culprit artery.
- No significant correlation was found between collateral circulation and RC.
- Independent predictors of RC included inferior infarction, RCA culprit vessel, low ejection fraction, and multi-vessel disease.
Conclusions:
- Concomitant reciprocal ST-segment depression in STEMI is not correlated with the presence of collateral vessels.
- The pathogenesis of RC likely involves remote ischemia due to multi-vessel coronary artery disease and electrical phenomena, rather than collateral circulation.
Objective:
Acute STEMI is often accompanied by reciprocal ST-segment depression (RC) occurring in opposite leads, whose significance has been debated for decades. The possible role of collateral circulation in promoting RC in acute STEMI has not been identified. So our aim to find the relationship between collateral circulation and RC in STEMI patients treated with primary percutaneous intervention (PPCI).
Methods:
The study included 112 pts. with acute STEMI underwent PPCI. The patients divided in to 2 groups: Group (A):66 pts. with RC, Group (B):46 pts without RC. All patients subjected to history taking, ECG [localization of infarction & RC], CKMB level, transthoracic echo [LVEF%], coronary angiography &PPCI to culprit artery and assess number of diseased vessels, site of occlusion, collaterals, TIMI flow pre and post PCI.
Results:
Patients in group A with RC had shorter time to door, P < 0.001; more frequent inferior infarctions, P < 0.001; had higher CKMB level, P < 0.001; higher LVEDD, P < 0.001; LVESD, P < 0.001and lower LVEF, P = 0.004; had multi vessel diseases P = 0.02, increase incidence of RCA as a culprit artery <0.001 compared to patients with no RC. Patients with RC had significantly higher incidence of proximal LAD occlusion, distal RCA and distal LCX compared to patients without RC. The percentage of change was 61.2 ± 12.35% for ST elevation and 50.5 ± 10.87% for reciprocal ST depression post PCI with significance difference between them, t = 3.035P = 0.0023.There was no significant correlation between collateral circulation and RC. We found four significant independent predictors of RC. They were inferior infarction (P = 0.024), RCA as a culprit vessel, (P = 0.034), low EF, (P = 0.007) and multi-vessel disease, (P = 0.022).
Conclusion:
There is no correlation between concomitant RC and presence of collateral vessels in acute STEMI patients. So the pathogenesis of reciprocal ST-segment changes result from an interplay of ischemia at distance due to multi-vessel CAD and benign mirror electrical changes not caused by collateral circulation diverting blood to ischemic area from non-diseased artery.
Related Concept Videos
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...