Spontaneous coronary collateral recruitment in patients with recurrent ST elevation myocardial infarction (STEMI)
- 19 Downloads
The spontaneous recruitment of acute coronary collaterals in the setting of an ST elevation myocardial infarction (STEMI) is seen frequently in those patients undergoing primary percutaneous coronary intervention (pPCI) and is associated with improved clinical outcomes. However, it is unknown whether in patients who present with a recurrent STEMI, the degree of collateral recruitment remains the same as in the index procedure. We reviewed all patients presenting to our tertiary centre with a STEMI undergoing primary or rescue percutaneous coronary intervention (PCI) from July 2010 until December 2018. We identified patients who presented with a recurrent STEMI following their index procedure. We defined patients with poor collateral recruitment as Rentrop grade 0 or 1, whilst patients with robust collateral recruitment as Rentrop grade 2 or 3. Of the 1795 patients who were identified, there were 27 cases in 25 patients who presented with a repeat STEMI following their index procedure. The median time between cases was 12.8 days (IQR 2.3–589.5 days). Compared to the index case, there was no statistically significant difference in the degree of collateral recruitment in recurrent presentations (Z = − 0.378, p = 0.70). In those patients presenting more than 6 months following the index procedure, the median time between cases was 654.5 days (IQR 479.5–1151.9). There was no difference in the degree of collateral recruitment in recurrent presentations (Z = 0.000, p = 1.0). Cases which had poorer collateral recruitment in recurrent presentations were less likely to be current smokers (0% vs 50%, p < 0.001) and less likely to have diabetes (0% vs 27.3%, p < 0.05) The recruitment of spontaneous coronary collaterals remains constant in recurrent STEMI presentations suggesting an innate biological process rather than merely a manifestation of alteration of haemodynamic blood flow. Further investigations to identify these processes is required.
KeywordsCollaterals Coronary collaterals STEMI Acute coronary syndrome Rentrop
Compliance with ethical standards
Conflicts of interest
All authors declare that they have no conflict of interest.
- 7.Hara M, Sakata Y, Nakatani D, Suna S, Nishino M, Sato H, Kitamura T, Nanto S, Hori M, Komuro I, Investigators O (2016) Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era: a prospective observational study. BMJ Open 6(7):e011105CrossRefGoogle Scholar
- 8.Hernandez-Perez FJ, Goirigolzarri-Artaza J, Restrepo-Cordoba MA, Garcia-Touchard A, Oteo-Dominguez JF, Silva-Melchor L, Fernandez-Diaz JA, Dominguez-Puente JR, Alonso-Pulpon L, Goicolea-Ruigomez J (2017) Impact of coronary collaterals on long-term prognosis in patients treated with primary angioplasty. Rev Esp Cardiol (Engl Ed) 70(3):178–185CrossRefGoogle Scholar
- 15.Antoniucci D, Valenti R, Moschi G, Migliorini A, Trapani M, Santoro GM, Bolognese L, Cerisano G, Buonamici P, Dovellini EV (2002) Relation between preintervention angiographic evidence of coronary collateral circulation and clinical and angiographic outcomes after primary angioplasty or stenting for acute myocardial infarction. Am J Cardiol 89(2):121–125CrossRefGoogle Scholar
- 18.Shen Y, Wu F, Pan C, Zhu T, Zhang Q, Zhang R, Ding F, Lu L, Hu J, Yang Z, Shen W, Wu Z (2014) Clinical relevance of angiographic coronary collaterals during primary coronary intervention for acute ST-elevation myocardial infarction. Chin Med J (Engl) 127(1):66–71Google Scholar
- 23.Brugaletta S, Martin-Yuste V, Padro T, Alvarez-Contreras L, Gomez-Lara J, Garcia-Garcia HM, Cola C, Liuzzo G, Masotti M, Crea F, Badimon L, Serruys PW, Sabate M (2012) Endothelial and smooth muscle cells dysfunction distal to recanalized chronic total coronary occlusions and the relationship with the collateral connection grade. JACC Cardiovasc Interv 5(2):170–178CrossRefGoogle Scholar