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Published on: June 28, 2019
Early recruitable coronary collaterals preserve miocardial viability in late presentation infarctions
Alejandro Gutiérrez-Barrios1,2, Inara Alarcón de la Lastra1, Lola Cañadas-Pruaño1,2
1Cardiology Department, Hospital Puerta del Mar.
Insights
Early recruited coronary collateral circulation (CCC) significantly improves myocardial viability and function in patients with late-presenting myocardial infarction (MI). This finding highlights the importance of CCC in managing non-reperfused MI cases.
Area of Science:
- Cardiology
- Cardiovascular Research
- Interventional Cardiology
Background:
- Conflicting results exist on coronary collateral circulation (CCC) 's role in myocardial infarction (MI).
- Early reperfusion in primary angioplasty may confound previous CCC studies.
- Investigating CCC in non-reperfused patients offers clarity on its true impact.
Purpose of the Study:
- To evaluate the effect of CCC on myocardial viability in late presentation MI.
- To assess the impact of early recruited CCC (ERCC) versus poor CCC (PCC) on cardiac function and viability.
- To identify predictors of myocardial viability in patients with delayed MI treatment.
Main Methods:
- 167 patients with late presentation MI and complete coronary occlusion were analyzed (2008-2019).
- Patients were categorized into ERCC (Rentrop 2-3) or PCC (Rentrop 0-1) groups.
- Myocardial viability, left ventricular ejection function (LVEF), and wall motion abnormalities were assessed.
Main Results:
- PCC patients showed lower LVEF and more severe wall motion abnormalities.
- ERCC was the primary independent predictor of myocardial viability (HR, 4.24; P < 0.001).
- ERCC patients demonstrated significant improvement in wall motion score and LVEF at follow-up compared to PCC patients.
Conclusions:
- Early recruited coronary collateral circulation is a key independent predictor of myocardial viability in late presentation MI.
- ERCC significantly enhances myocardial recovery and function in non-reperfused MI.
- These findings underscore the therapeutic importance of robust collateral circulation in managing complex MI cases.
Background:
Previous studies showed conflicting results regarding the contribution of coronary collateral circulation (CCC) to myocardial perfusion and function in the setting of myocardial infarction (MI). In the primary angioplasty era, the role of CCC in these studies may have been influenced by the effect of early reperfusion. The true impact of CCC could be clarified by studying its effect on nonreperfused patients. The aim of our study was to evaluate the effect of CCC on myocardial viability of late presentation MI.
Methods And Results:
Between 2008 and 2019, we included 167 patients with a late presentation MI who had a complete angiographic occlusion in a major coronary artery in which myocardial viability of the culprit territory was assessed. Patients were divided according to the presence of angiographic early recruited CCC (ERCC) (Rentrop 2-3) or poor CCC (PCC) (Rentrop 0-1). A lower left ventricular ejection function (LVEF) at discharge (54.2 ± 9 vs. 47.9 ± 12; <0.01) and a more severe left ventricular wall motion abnormalities in the culprit territory were observed in PCC patients. The presence of ERCC was the main independent predictor of myocardial viability in late presentation MI (hazard ratio, 4.24; 95% confidence interval, 1.68-10.6; P < 0.001). At follow-up, wall motion score increased significantly (2.05 ± 0.16; P = 0.02) in patients with ERCC but not in PCC patients (0.07 ± 0.16; P = 0.4), and LVEF improvement was significantly higher in ERCC than in PCC patients (9.7 ± 2.6 vs. 3.8 ± 4.2; P = 0.02).
Conclusion:
The presence of ERCC was the main independent predictor of myocardial viability in late presentation MI.
