Abstract
Aims
The role of collateral flow in the first hours of infarction remains unclear. Our aim was to determine whether the presence of coronary collateral flow, as evidenced by angiography, has a beneficial effect on infarct size and left ventricular function in acute myocardial infarction (MI) treated by means of early percutaneous coronary intervention (PCI).
Methods
Between 1994 and 2001, 1059 patients with acute MI treated with primary PCI, TIMI (Thrombolysis in Myocardial Infarction) 0 or 1 flow at first contrast injection and technically adequate angiograms for collateral flow detection were analysed.
Results Comparison of collateral flow grades 0, 1, and 2/3 showed that increased collateral flow was associated with a lower incidence of Killip class ⩾2 at presentation (12% vs. 10% vs. 3%,
pp for trend 0.02), less need for intra-aortic balloon pumping after PCI (17% vs. 13% vs. 5%, pp for trend 0.005), better myocardial blush grade (MBG) in infarcts related with the left anterior descending coronary artery (LAD) (MBG3: 14% vs. 18% vs. 34%, pp for trend 0.01), and smaller enzymatic infarct size (cumulative lactate dehydrogenase release 36 h after symptom onset [LDHQ36]) (1932±1531 U/l vs. 1870±1458 U/l vs. 1217±762 U/l, pp for trend 0.041). These beneficial effects were particularly evident in LAD-related infarcts.
Conclusion
The presence of angiographically detectable collaterals has a protective effect on enzymatic infarct size and pre- and postintervention haemodynamic conditions in patients with acute MI treated by primary PCI, in particular when Rentrop grade 2/3 is present and the LAD is involved in the infarct.
The role of collateral flow in the first hours of infarction remains unclear. Our aim was to determine whether the presence of coronary collateral flow, as evidenced by angiography, has a beneficial effect on infarct size and left ventricular function in acute myocardial infarction (MI) treated by means of early percutaneous coronary intervention (PCI).
Methods
Between 1994 and 2001, 1059 patients with acute MI treated with primary PCI, TIMI (Thrombolysis in Myocardial Infarction) 0 or 1 flow at first contrast injection and technically adequate angiograms for collateral flow detection were analysed.
Results Comparison of collateral flow grades 0, 1, and 2/3 showed that increased collateral flow was associated with a lower incidence of Killip class ⩾2 at presentation (12% vs. 10% vs. 3%,
pp for trend 0.02), less need for intra-aortic balloon pumping after PCI (17% vs. 13% vs. 5%, pp for trend 0.005), better myocardial blush grade (MBG) in infarcts related with the left anterior descending coronary artery (LAD) (MBG3: 14% vs. 18% vs. 34%, pp for trend 0.01), and smaller enzymatic infarct size (cumulative lactate dehydrogenase release 36 h after symptom onset [LDHQ36]) (1932±1531 U/l vs. 1870±1458 U/l vs. 1217±762 U/l, pp for trend 0.041). These beneficial effects were particularly evident in LAD-related infarcts.
Conclusion
The presence of angiographically detectable collaterals has a protective effect on enzymatic infarct size and pre- and postintervention haemodynamic conditions in patients with acute MI treated by primary PCI, in particular when Rentrop grade 2/3 is present and the LAD is involved in the infarct.
| Original language | English |
|---|---|
| Pages (from-to) | 854-858 |
| Number of pages | 5 |
| Journal | European Heart Journal |
| Volume | 25 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - 1-May-2004 |
Keywords
- primary coronary angioplasty
- myocardial infarction
- collateral circulation
- enzymatic infarct size
- BLOOD-FLOW
- PRIMARY ANGIOPLASTY
- ANGIOGRAPHIC ASSESSMENT
- THROMBOLYTIC THERAPY
- ARTERY OCCLUSION
- TIMI TRIAL
- REPERFUSION
- RISK
- AREA
- HUMANS