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Published on: May 28, 2019
The effect of interarm blood pressure difference on coronary collateral flow in patients with ST-segment elevation
R Zehir1, B Güvendi Şengör, C Yılmaz
1Department of Cardiology, Kartal Kosuyolu Research and Education Hospital, Kartal, Istanbul, Turkey. regayipz@outlook.com.
Insights
An interarm blood pressure difference (IABPD) is an independent predictor of poor coronary collateral circulation (CCC) in ST-segment elevation myocardial infarction (STEMI) patients. This finding highlights IABPD as a potential indicator for assessing collateral flow in STEMI management.
Area of Science:
- Cardiology
- Vascular Physiology
Background:
- Coronary collateral circulation (CCC) is crucial in acute myocardial infarction (AMI), influencing infarct size, cardiac function, and mortality.
- An interarm blood pressure difference (IABPD) is an independent predictor of cardiovascular and all-cause mortality.
Purpose of the Study:
- To investigate the effect of IABPD on coronary collateral flow in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (p-PCI).
Main Methods:
- A prospective study of 1,348 STEMI patients who underwent p-PCI.
- Coronary collateral circulation (CCC) was assessed using the Rentrop classification (0-1: poor, 2-3: good).
- Interarm blood pressure difference (IABPD) was measured, with a 10 mm Hg difference considered the upper limit.
Main Results:
- 24% of patients (325) had good CCC, while 76% (1,023) had poor CCC.
- IABPD was significantly higher in the poor CCC group (5.6%) compared to the good CCC group (2.8%) (p=0.04).
- Pre-infarction angina and IABPD were independent predictors of poor collateral circulation in multivariate analysis.
Conclusions:
- Interarm blood pressure difference (IABPD) is an independent predictor of poor collateral circulation in STEMI patients undergoing p-PCI.
- IABPD may serve as a valuable clinical indicator for assessing collateral flow in STEMI.
Objective:
In patients with acute myocardial infarction, coronary collateral circulation (CCC) is associated with reduced infarct size, preserved cardiac function, and decreased mortality. An interarm blood pressure difference (IABPD) is shown to be independently associated with cardiovascular and all-cause of mortality. We aimed to determine the effect of IABPD on coronary collateral flow in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (p-PCI).
Patients And Methods:
We prospectively investigated 1,348 consecutive patients who were hospitalized for STEMI and underwent p-PCI. The Rentrop classification was used to assess CCC. According to this classification, we defined Rentrop 0 and 1 as poor CCC, and Rentrop 2 and 3 as good CCC. A 10 mm Hg difference is considered the upper limit of IABPD.
Results:
Patients were divided into two groups according to the collateral circulation, 325 patients (24%) had good collateral, while 1,023 patients (76%) had poor collateral. IABPD was significantly higher in the poor collateral group (57 patients, 5.6%) than in the good collateral group (9 patients, 2.8%) (p=0.04). Pre-infarction angina and IABPD were identified as independent predictors of poor collateral (OR: 0.516, 95% CI 0.370-0.631, p=0.007; OR: 3.681, 95% CI: 1.773-7.461, p=0.01, respectively) in multivariate analysis.
Conclusions:
The IABPD was shown as an independent predictor of poor collateral circulation in patients with STEMI who underwent p-PC.
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