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European Heart Journal 2004 25(10):854-858; doi:10.1016/j.ehj.2004.03.005
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Role of collateral circulation in the acute phase of ST-segment-elevation myocardial infarction treated with primary coronary intervention

P Elsmana,*, A.W.J van `t Hofa, M.J de Boera, J.C.A Hoorntjea, H Suryapranataa, J.H.E Dambrinka and F Zijlstrab on behalf of the Zwolle Myocardial Infarction Study Group

a Department of Cardiology, Isala Klinieken, Locatie Weezenlanden, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands
b Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands

* Tel.: +31-3842-42374; fax: +31-3842-43222
E-mail address: v.derks{at}diagram-zwolle.nl

Received 30 October 2002; revised 18 February 2004; accepted 11 March 2004

Abstract

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%, for trend 0.02), less need for intra-aortic balloon pumping after PCI (17% vs. 13% vs. 5%, 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%, for trend 0.01), and smaller enzymatic infarct size (cumulative lactate dehydrogenase release 36 h after symptom onset [LDHQ36]) (1932±1531 U/l vs. 1870±1458 U/l vs. 1217±762 U/l, 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.

Key Words: Primary coronary angioplasty • Myocardial infarction • Collateral circulation • Enzymatic infarct size


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