Evolving Role of Coronary Collaterals in STEMI Outcomes: A Comparative Analysis of Pandemic and Post-Pandemic Phases

Area of Science:

• Cardiology
• Emergency Medicine
• Public Health

Background:

• Acute ST-elevation myocardial infarction (STEMI) management is crucial, with coronary collaterals offering protection against myocardial damage.
• The COVID-19 pandemic presented unprecedented challenges in STEMI care, potentially impacting treatment efficacy and patient outcomes.
• Understanding the role of coronary collaterals during and after the pandemic is vital for optimizing STEMI management strategies.

Purpose of the Study:

• To evaluate the protective efficacy of coronary collaterals in STEMI patients during the COVID-19 pandemic compared to the post-pandemic period.
• To analyze the impact of collateral status on in-hospital mortality and 1-year major adverse cardiac events (MACE) in these two distinct timeframes.
• To investigate potential changes in collateral functionality and protective capacity influenced by the pandemic.

Main Methods:

• A retrospective review of 1465 STEMI patients treated between April 2020 and December 2022 at a high-volume tertiary care center.
• Assessment of coronary collaterals using the established Rentrop classification system.
• Comparative analysis of in-hospital mortality and 1-year MACE rates stratified by collateral status and pandemic/post-pandemic periods.

Main Results:

• During the pandemic, a higher incidence of robust collaterals was observed (28.2% vs 23.2%), but they offered diminished protection, with similar mortality (14.4% vs 8.1%) and MACE rates (21.9% vs 30.4%) compared to the post-pandemic group.
• Post-pandemic, robust collaterals demonstrated significant protective effects, correlating with reduced in-hospital mortality (3.6% vs 7.4%) and 1-year MACE (17.1% vs 24.9%).
• These findings indicate a potential impairment in collateral functionality during the pandemic, affecting their protective capacity in STEMI.

Conclusions:

• Coronary collaterals play a dynamic role in STEMI management, with their protective efficacy potentially compromised during the COVID-19 pandemic.
• The pandemic era necessitated adaptive strategies in STEMI care due to observed changes in collateral function.
• Further research is warranted to elucidate the mechanisms behind pandemic-related alterations in collateral function and to develop resilient STEMI care protocols for future health crises.