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Assessment of Coronary Collaterals Among Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary
Zafar Iqbal1, Muhammad N Mengal1, Tariq Ashraf1
1National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
Insights
Good coronary collaterals (CC) were present in over a quarter of ST-segment elevation myocardial infarction (STEMI) patients. However, this study found no significant impact of CC on in-hospital or 30-day mortality after primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary collaterals (CC) play a role in myocardial perfusion.
- Their significance in ST-segment elevation myocardial infarction (STEMI) post-primary percutaneous coronary intervention (PCI) requires further elucidation.
- The Rentrop Collateral Score (RCS) is a standard method for grading CC.
Purpose of the Study:
- To determine the distribution of coronary collaterals (CC) using the Rentrop Collateral Score (RCS) in STEMI patients.
- To assess the impact of CC on in-hospital and 30-day mortality after primary PCI.
Main Methods:
- A cohort of 347 STEMI patients undergoing primary PCI was analyzed.
- Coronary collaterals were graded using the Rentrop Collateral Score (RCS).
- Patients were followed for in-hospital and 30-day major adverse cardiovascular events (MACE).
Main Results:
- Good CC (RCS 2-3) were observed in 30.3% of patients.
- No significant difference in in-hospital mortality (2% vs. 4.9%) or 30-day MACE (7% vs. 6.4%) was found between patients with and without good CC.
- The presence of CC did not significantly affect short-term clinical outcomes.
Conclusions:
- Over a quarter of STEMI patients exhibit good coronary collateral circulation.
- Despite the presence of good CC, no significant benefit was observed regarding in-hospital or 30-day mortality after primary PCI.
- The prognostic value of good CC in this setting warrants further investigation.
Objectives:
This study aimed to determine the distribution of coronary collaterals (CC) as per the Rentrop Collateral Score (RCS) among patients with ST-segment elevation myocardial infarction (STEMI) and its impact on in-hospital and 30-day mortality after primary percutaneous coronary intervention (PCI).
Methods:
In this study, a selected sample of consecutive STEMI patients was assessed for the development of CC as per the RCS classification. An RCS grade of 2 or 3 was taken as the presence of CC with either partial or complete filling of the infarct-related artery (IRA). Patients were followed during the hospital stay and up to 30 days, and the incidence of major adverse cardiovascular events (MACE) was recorded, which included mortality, re-infarction, stroke, and hospitalization due to heart failure.
Results:
This study was conducted on a sample of 347 patients; 81.6% (283) were male, and the mean age was 56.2 ± 10.3 years. CC was not visible (RCS-0) in 206 (59.4%) patients, visible but without filling of the IRA (RCS-1) in 39 (11.2%) patients, and visible with partial (RCS-2) and complete (RCS-3) filling of the IRA in 72 (20.7%) and 30 (8.6%) patients, respectively. No significant differences were observed in the incidence of in-hospital mortality and short-term MACE between patients with and without CC, with an in-hospital mortality rate of 2% vs. 4.9% (p = 0.248) and a MACE rate of 7% vs. 6.4% (p = 0.850), respectively.
Conclusion:
Good CC with either partial or complete filling of the IRA was observed in more than one-fourth of the patients with STEMI. However, no significant benefits of good CC were observed.
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