Impact of Coronary Collateral Circulation on In-Hospital Death in Patients with Inferior ST Elevation Myocardial Infarction

Abstract

Objectives. Coronary collateral circulation (CCC) may limit the size of right ventricular (RV) infarcts but does not fully explain the relationship between CCC and clinical adverse events in patients with inferior STEMI. In this study, it was aimed to assess the relationship between preintervention angiographic evidence of CCC and clinical outcomes in patients with inferior STEMI who have undergone percutaneous coronary intervention. Methods. A total of 235 inferior STEMI patients who presented within the first 12 hours from the symptom onset were included. CCC to the right coronary artery (RCA) before angioplasty were angiographically assessed, establishing two groups: 147 (63%) patients without CCC and 88 (37%) with CCC according to presence of CCC. Results. RV infarction, complete atrioventricular block, VT/VF, cardiogenic shock, and in-hospital death were noted less frequently in patients with CCC than in those without CCC. Absence of CCC to RCA was found to be the independent predictor for in-hospital death among them (odds ratio 4.0, 95% CI 1.8–12.6; p = 0.03). Conclusion. Presence of angiographically detectable CCC was associated with better in-hospital outcomes including RV infarction, complete AV block, cardiogenic shock, and VT/VF in patients with inferior STEMI.

Plasma Omentin-1 Level as a Predictor of Good Coronary Collateral Circulation

“…Studies have shown the important clinical significance of pre-existent CCC that decreased in-hospital death from anterior myocardial infarction 4 ) . Moreover, the presence of good CCC was associated with better clinical outcomes including long-term survival, major adverse cardiovascular event rates, right ventricular infarction, complete atrioventricular block, cardiogenic shock, and ventricular tachycardia/ventricular fibrillation in patients with acute and inferior ST-elevation myocardial infarction 5 , 6 ) .…”

Proximal complete occlusion of right coronary artery presenting with precordial ST-segment elevation

“…[ 18 ] The nondominant RCA and no coronary collateral circulation increased the incidence of VF in patients with the occlusion of RCA. [ 19 , 20 ] We speculated the higher ST-segment elevation in precordial leads V1–V3 of postdefibrillation ECG caused by electrical cardioversion. In fact, the phenomenon of electrical cardioversion leading to slight ST-segment elevation in precordial leads was reported in previous study, and they normalized within several minutes after the electrical shock.…”

The Results of Use of New Native Thrombolytic in Clinical Practice

“…Конечно, отсутствие работающих коллатералей при эффективном тромболизисе может объясняться удовлетворительным антеградным кровотоком. В то же время, несмотря на доказанное благоприятное влияние коллатерального кровотока на риск осложнений инфаркта миокарда и прогноз пациентов [16,17], можно предположить, что наличие коллатералей при неэффективном тромболизисе указывает не только на более длительный стаж атеросклеротической болезни и феномен ишемического прекондиционирования, но и на более тяжелое исходное анатомическое поражение коронарного русла пациентов, включенных в данное исследование, предопределившее в ряде случаев не только неудачу реперфузионной терапии, но и более высокую летальность в сравнении с данными РКИ. Наконец, нельзя исключить и возможный благоприятный потенцирующий эффект проведенной тромболитической терапии в отношении функционирования коллатералей и восстановления в конечном счете перфузии миокарда, что подтверждается еще и снижением сегмента ST на ЭКГ до изолинии даже в отсутствие антеградного кровотока по инфарктсвязанной артерии.…”