Clinical significance and determinants of prompt recruitment collaterals during primary percutaneous coronary intervention

Abstract

A b s t r a c tBackground: Due to ischaemic time delays from the chest pain occurrence in acute ST elevation myocardial infarction (STEMI), prompt recruitment collaterals (PRCCs) to infarct-related artery (IRA) are the major protective structures during this period. Aim:We aimed to investigate the clinical significance and determinants of PRCCs in acute STEMI patients. Methods:A total of 1375 consecutive acute STEMI patients were prospectively enrolled in the study. The patients were divided into two groups, according to PRCCs to IRA; Rentrop ≤ 1 were defined as inadequate collateral development (ICD) group and Rentrop ≥ 2 defined as adequate collateral development (ACD) group.Results: Patients in the ICD group had higher incidence of baseline risk characteristics, including older age, hypertension, and diabetes mellitus; however, pre-infarct angina incidence was lower than in the ACD group (p < 0.05 for all). In addition, the ICD group had worse haemodynamic status on admission and 30-day mortality. Compared to the ACD group, the non-IRA chronic total occlusion (CTO), peak troponin-T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high sensitivity C-reactive protein (hs-CRP) levels were higher in the ICD group. On multivariate logistic regression analysis, non-IRA CTO (b = 3.114, 95% CI 1.382-7.017, p < 0.006) with pre-infarction angina together with higher values of peak troponin-T, NT-proBNP, and hs-CRP were associated with PRCCs in acute STEMI. Conclusions:Taking into account that the main message of the study is that if patients have higher cardiac biomarkers and adverse clinical findings (which, of note, may show the extent of myocardial infarction) and have non-IRA CTO, there is a higher chance that they will have inadequate collateralisation.

Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

“…Failure to recanalize CTO lesion in diabetes was found to have higher residual platelet reactivity (HRPR) which may in turn increase cardiac mortality [18]. In the present study, we found similar result that diabetes mellitus was related to poor prognosis in patients with CTO lesions [19]. Potential mechanisms for collateral developments were arteriogenesis, (i.e., arterialization of capillary bed) and angiogenesis [20].…”

Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

“…Sen O et al found out that diabetes was related to higher incidence of inadequate collateral development in acute coronary syndrome. [19] Potential mechanisms for collateral developments were arteriogenesis, (i.e., arterialization of capillary bed) and angiogenesis. [20] However, chronic hyperglycemia induced microvascular rarefaction in myocardium.…”

Incomplete protective effect of coronary collateral circulation for acute myocardial infarction patients

“…the worse clinical profiles may mask mortality benefit of CCC [ 18 ] because CCC patients have more cardiovascular risk factors which were promotive factors for atherosclerosis, [ 17 , 19 ] and in fact their coronary stenosis were heavier as showed in this research. The more serious the coronary stenosis extent, the greater probability of CCC formation because ischemia and hypoxia were strong stimulative factors for CCC formation.…”