Angiographically detectable collateral flow (grade 2/3 vs 0) in acute MI treated by primary PCI was associated with smaller enzymatic infarct size (1217 vs 1932 U/l; p for trend=0.041).
Observational (n=1,059)
Does the presence of coronary collateral flow reduce infarct size and improve haemodynamic conditions in patients with acute MI treated with primary PCI?
The presence of angiographically detectable collaterals, particularly Rentrop grade 2/3 in LAD-related infarcts, has a protective effect on enzymatic infarct size and haemodynamic status in acute MI patients undergoing primary PCI.
p-value: p=0.041
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%, p for trend 0.02), less need for intra-aortic balloon pumping after PCI (17% vs. 13% vs. 5%, p 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%, p for trend 0.01), and smaller enzymatic infarct size (cumulative lactate dehydrogenase release 36 h after symptom onset LDHQ(36)) (1932+/-1531 U/l vs. 1870+/-1458 U/l vs. 1217+/-762 U/l, p 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.
Peter Elsman (Thu,) conducted a observational in acute ST-segment-elevation myocardial infarction (n=1,059). Coronary collateral flow vs. Absence of collateral flow was evaluated on enzymatic infarct size (cumulative lactate dehydrogenase release 36 h after symptom onset) (p=0.041). Angiographically detectable collateral flow (grade 2/3 vs 0) in acute MI treated by primary PCI was associated with smaller enzymatic infarct size (1217 vs 1932 U/l; p for trend=0.041).