Key result
Acute coronary collaterals are linked to ~50% lower 5-year mortality versus no collaterals.
Why the study?
Does the presence of acute phase coronary collaterals improve in-hospital and 5-year mortality in STEMI patients with completely occluded infarct-related arteries?
Observational (n=3,340)
Yes
Does the presence of acute phase coronary collaterals improve in-hospital and 5-year mortality in STEMI patients with completely occluded infarct-related arteries?
Answers are grounded in this paper and cite their sources.
Minimal to moderate acute phase coronary collaterals are associated with improved in-hospital and 5-year mortality in STEMI patients with occluded arteries, whereas the benefit of extensive collaterals may be masked by worse baseline clinical profiles.
OBJECTIVES: To evaluate the short-term and long-term prognostic impacts of acute phase coronary collaterals to occluded infarct-related arteries (IRA) after ST-elevation myocardial infarction (STEMI) in the percutaneous coronary intervention (PCI) era. DESIGN: A prospective observational study. SETTING: Osaka Acute Coronary Insufficiency Study (OACIS) in Japan. PARTICIPANTS: 3340 patients with STEMI from the OACIS database who were admitted to hospitals within 24 hours from the onset and who had a completely occluded IRA. INTERVENTIONS: Patients were divided into 4 groups according to the Rentrop collateral score (RCS) by angiography on admission (RCS-0, no visible collaterals; RCS-1, collaterals without IRA filling; RCS-2, collaterals with partial IRA filling; and RCS-3, collaterals with complete IRA filling). PRIMARY OUTCOME MEASURES: In-hospital and 5-year mortality. RESULTS: Patients with RCS-0/3 were older than patients with RCS-1/2, and the prevalence of previous myocardial infarction was highest in patients with RCS-3. Median peak creatinine phosphokinase levels decreased as RCS increases (p<0.001), suggesting the acute cardioprotective effects of collaterals. Although RCS-1 and RCS-2 collaterals were associated with better in-hospital mortality (adjusted OR 0.48, p=0.046 and 0.38, p=0.010 for RCS-1 and RCS-2, respectively) and 5-year mortality (adjusted HR 0.53, p=0.004 and 0.46, p<0.001 for RCS-1 and RCS-2, respectively) as compared with R-0, presence of RCS-3 collaterals was not associated with improved in-hospital (adjusted OR 1.35, p=0.331) and 5-year mortality (adjusted HR 0.98, p=0.920), possibly because worse clinical profiles in patients with RCS-3 may mask mortality benefit of coronary collaterals. CONCLUSIONS: Presence of acute phase coronary collaterals such as RCS-1 and RCS-2 were associated with better in-hospital and 5-year mortality after STEMI in the contemporary PCI era.
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Hara et al. (2016) conducted an observational in ST-elevation myocardial infarction (n=3,340). Acute phase coronary collaterals (Rentrop collateral score 1) vs. No visible collaterals (Rentrop collateral score 0) was evaluated on 5-year mortality (HR 0.53, 95% CI 0.34 to 0.82, p=0.004). Presence of minimal (RCS-1) or moderate (RCS-2) acute phase coronary collaterals was associated with significantly lower 5-year mortality (HR 0.53 and 0.46, respectively) compared to no collaterals.
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