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Predictors of Coronary Collateral Circulation in Patients with Acute ST-segment Elevation Myocardial Infarction: A
Hongxia Shao1, Wenling Zhao1, Zhao Li1
1Department of Cardiology, The People's Hospital of Dangshan County, 235300 Suzhou, Anhui, China.
Insights
Predicting coronary collateral circulation (CCC) in ST-segment elevation myocardial infarction (STEMI) is vital. A history of coronary heart disease, fibrinogen levels, and specific artery closures are key predictors, aiding personalized treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Prediction Models
Background:
- Coronary collateral circulation (CCC) plays a critical role in mitigating damage during acute myocardial infarction.
- Identifying early predictors of CCC in ST-segment elevation myocardial infarction (STEMI) is essential for risk stratification and treatment planning.
Purpose of the Study:
- To identify early predictors of CCC in STEMI patients.
- To develop and validate a nomogram for predicting the presence of CCC in STEMI patients.
Main Methods:
- Retrospective study of 668 STEMI patients (167 with CCC, 501 without).
- Utilized logistic regression (LASSO, univariable, multivariable) to identify independent predictors.
- Developed and validated a predictive nomogram using ROC analysis, calibration curves, and decision curve analysis.
Main Results:
- Independent predictors of CCC included history of coronary heart disease (CHD), osmolality, fibrinogen levels, and closure of the left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA).
- The Gensini score was also identified as a significant predictor.
- The developed nomogram demonstrated good predictive accuracy and calibration.
Conclusions:
- History of CHD, osmolality, fibrinogen levels, LAD, LCX, and RCA closures, along with the Gensini score, are significant independent predictors of CCC in STEMI.
- The established nomogram provides a valuable clinical tool for identifying patients with CCC, facilitating personalized therapeutic strategies.
Background:
Coronary collateral circulation (CCC) is a crucial protective mechanism in acute myocardial infarction. This study aimed to identify early predictors of CCC in patients with acute ST-segment elevation myocardial infarction (STEMI) and develop a nomogram for predicting its presence.
Methods:
We conducted a retrospective study of STEMI patients admitted to the Beijing Friendship Hospital from January 2015 to December 2023. Patients with CCC, as confirmed by coronary angiography, were matched 1:3 with those without CCC based on the date of admission. We compared baseline characteristics, laboratory parameters, coronary features, and in-hospital outcomes between the two groups. Variable selection was performed using least absolute shrinkage and selection operator (LASSO) regression analysis, followed by univariable and multivariable logistic regression analyses to identify independent predictors of CCC. A nomogram was constructed based on significant predictors and was validated through receiver operating characteristic (ROC) curve analysis, calibration curves, and decision curve analysis.
Results:
A total of 668 patients with STEMI were included in the study (501 without CCC and 167 with CCC). Patients with CCC had a higher prevalence of right coronary artery (RCA) closure and multi-vessel disease, as well as elevated inflammatory markers and altered coagulation parameters. Multivariable logistic regression analysis identified a history of coronary heart disease (CHD), osmolality, levels of fibrinogen, and left anterior descending (LAD) artery closure, left circumflex (LCX) artery closure, and RCA closures, as well as the Gensini score, were independent predictors of CCC. The nomogram incorporating these predictors demonstrated good discrimination and calibration, indicating an accurate prediction of the presence of CCC.
Conclusions:
History of CHD, osmolality, levels of fibrinogen, LAD, LCX, and RCA closures, as well as the Gensini score, are independent predictors of CCC in patients with STEMI. The developed nomogram offers a clinically useful tool for identifying patients likely to have CCC, potentially aiding in personalized treatment strategies.
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