The Relationship Between Coronary Collateral Circulation and In-hospital Mortality in Patients with First Acute Anterior STEMI

Öz

Aim: The aim of the present study is to investigate the prognostic value of Coronary Collateral Circulation (CCC) in patients with the first acute anterior wall ST Elevation Myocardial Infarction (STEMI) undergoing primary percutaneous coronary intervention w (p-PCI). Material and Method: A total of 220 Patients with first acute Anterior STEMI within first 6th hours undergoing p-PCI were divided into 2 groups with respect to absence of CCC and presence of CCC. Coronary collateral flow to the infarct related artery (IRA) was graded on baseline angiograms with the use of qualitative classification by Rentrop. Results: A total of 220 patients mean age was of 61.4±12.3 years with first acute Anterior STEMI undergoing p-PCI were included the study. 34% of patients had CCC. The present study consisted of 64 female (29%) and 156 male (71%) patients. There were no statistically significant differences in respect to demographic characteristics, risk factors of coronary artery disease, LVEF, KILLIP classes, time from symptomps onset to PCI, door to baloon time, preprocedural and postprocedural angiographic characteristics and clinical outcomes which included cardiogenic shock on admission, cardiogenic shock in-hospital, fatal ventricular arrhtymias, complet AV block, mechanical complications and in-hospital mortality between the groups. In a stepwise backward multivariable logistic regression model, the independent prognostic indicators for in-hospital mortality were age (odds ratio [OR] 1.08, 95% CI 1.07 to 1.26, p=0.03), Time from symptoms onset to PCI (odds ratio [OR] 1.6, 95% CI 1.06 to 2.59, p=0.04) and unsuccessful p-PCI (odds ratio [OR] 3.3, 95% CI 1.04 to 10.9, p=0.04). Conclusion: Presence of CCC was not associated with in-hospital mortality in patients presenting with first acute Anterior STEMI undergoing p-PCI within first 6th hours.

Anahtar Kelimeler

• acute anterior STEMI,coronary collateral circulation,in-hospital mortality

İlk Akut Önduvar ST Elevasyonlu Miyokart Enfarktüsü Geçiren Hastalarda Koroner Kollateral Dolaşım ile Hastane İçi Ölüm Arasındaki İlişki

Öz

Amaç: Çalışmada ilk akut önduvar ST Elevasyonlu Miyokart Enfarktüsü (STEMI) geçirip Primer Perkütan Koroner Girişim (p-PKG) uygulanmış hastalarda Koroner Kollateral Dolaşımın (KKD) prognostik değerinin araştırılmasını amaçlanmaktadır. Materyal ve Metot: İlk akut önduvar STEMI geçiren, ilk 6 saat içinde p-PKG uygulanan toplam 220 hasta KKD varlığı ve yokluğuna göre 2 gruba ayrıldı. Başlangıç anjiogramlarda, enfarkttan sorumlu artere doğru oluşan koroner kollateral kan akımı Rentrop kalitatif sınıflama yöntemi kullanılarak derecelendirildi. Bulgular: İlk akut önduvar STEMI geçiren p-PKG uygulanan ortalama yaşları 61,4±12,3 olan toplam 220 hasta çalışmamıza dahil edildi. Hastaların %34’ünde KKD mevcuttu. Çalışmamıza alınan hastaların 64’ü (%29) kadın 156’sı (%71) erkekler oluşturmaktaydı. Gruplar arasında demografik özellikler, sol ventrikül ejeksiyon fraksiyonu, KILLIP sınıfları, koroner arter hastalığı risk faktörleri, semptomların başlangıcından p-PCI yapılıncaya kadar geçen süre, balon-kapı süresi, periprosedürel ve postprosedürel anjiografik özellikler ile başvuru anında Kardiyojenik Şok, Hastane içi Kardiyojenik Şok, Ölümcül Ventriküler Aritmiler, Komplet AV blok, Mekanik Komplikasyonlar ve Hastane içi Ölümü içeren klinik sonlanımlar arasında istatiksel olarak anlamlı farklılık mevcut değildi. Çoklu değişkenli logistik regresyon analizinde yaş ([OR] 1,08, 95 %CI 1,07 to 1,26, p=0,03), Semptomların başlangıcından p-PKG yapılıncaya kadar geçen süre ([OR] 1,6, 95 %CI 1,06 to 2,59, p=0,04), başarısız p-PKG ([OR] 3,3, 95 %CI 1,04 to 10,9, p=0,04) hastane-içi ölüm için bağımsız tahmin ettiriciler olarak olarak bulundu. Sonuç: Çalışmada ilk akut önduvar STEMI geçiren, ilk 6 saat içinde p-PKG uygulanan hastalarda KKD ile hastane-içi ölüm arasında ilişki tespit edilememiştir.

Anahtar Kelimeler

• akut önduvar STEMI,koroner kollateral dolaşım,hastane içi ölüm

Kaynakça

1. 1. Bache RJ, Schwartz JS. Myocardial blood flow during exercise aftergradual coronary occlusion in the dog. Am J Physiol 1983, 245: H131-H138.
2. 2. Rentrop KP, Cohen M, Blanke H, Phillips RA. Changes in collateral channelfilling immediately after controlled coronary artery occlusion by anangioplasty balloon in human subjects. J Am Coll Cardiol 1985, 5:587–92.
3. 3. Wustmann K, Zbinden S, Windecker S, Meier B, Seiler C. Is there functional collateralflow during vascular occlusion in angiographically normal coronary arteries? Circulation 2003;107:2213–20.
4. 4. Werner GS, Ferrari M, Betge S, Gastmann O, Richartz BM, Figulla HR. Collateral function in chronic total coronary occlusions is related toregional myocardial function and duration of occlusion. Circulation 2001, 104:2784–90.
5. 5. Fefer P, Knudtson ML, Cheema AN, Galbraith PD, Osherov AB, Yalonetsky S et al. Current perspectives on coronary chronic total occlusions: The Canadian multicenter chronic total occlusions registry. J AmColl Cardiol 2012;59:991–7.
6. 6. Van der Hoeven NW, Teunissen PF, Werner GS, Delewi R, Schirmer SH, Traupe T et al. Clinical parameters associated with collateral development in patients with chronic total coronary occlusion. Heart 2013 Aug; 99(15):1100–5.
7. 7. Lee JH, Kim CY, Kim N, Jang SY, Bae MH, Yang DH et al. Coronary collateral function and clinical outcome betwwen patients with acute and chronic total occlusion. JACC Cardiovasc Interv 2017 Mar 27;10(6):585–93.
8. 8. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, BlömstromLundgvist C, Borger MA et al. Eur Heart J 2012 Oct; 33(20):2569–619.

9. 9. Kolh P, Wijns W. Joint esc/eacts guidelines on myocardial revascularization. J Cardiovasc Med (Hagerstown) 2011;12:264–7.
10. 10. Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J et al. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I. a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 1987;76:142–54.
11. 11. Van’t Hof AWJ, Lief A, Suryapranata H, Hoorntje JC, de Boer MJ, Zijlstra F. Angiographic assessment of myocardial reperfusion in patients treated with primary angioplasty for acute myocardial infarction. Myocardial blush grade. Circulation 1998;97:2302–6.
12. 12. Seiler C. The human coronary collateral circulation. Eur J Clin Invest 2010;40:465–76.
13. 13. Elsman P, van’t Hof AW, de Boer MJ, Hoorntje JC, Suryapranata H, Dambrink JH et al. Role of collateral circulation in the acute phase of STsegment-elevation myocardial infarction treated with primary coronary intervention. Eur Heart J 2004, 25:854–8.
14. 14. Meier P, Gloekler S, de Marchi SF, Zbinden R, Delacretaz E, Seiler C. An indicator of sudden cardiac death during brief coronary occlusion: electrocardiogram QT time and the role of collaterals. Eur Heart J 2010;31:1197–1204.
15. 15. Kim EK, Choi JH, Song YB, Hahn JY, Chang SA, Park SJ et al. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction. Am Heart J 2016 Jan; 171(1):56–63.
16. 16. Meier P, Hemingway H, Lansky AJ, Knapp G, Pitt B, Seiler C. The impact of the coronary collateral circulation on mortality: a meta-analysis. Eur Heart J 2012;33(5):614–21.
17. 17. Akin S, Yetgin T, Brugts JJ, Dirkali A, Zijlstra F, Cleophas TJ. Effect of collaterals on deaths and re-infarctions in patients with coronary artery disease: a meta analysis. Neth Heart J 2013;21:146–51.
18. 18. Pe´rez-Castellano N, Garcia E, Abeytua M, Soriano J, Serrano JA, Elízaqa J et al. Influence of collateral circulation on inhospital death from anterior acute myocardial infarction. J Am Coll Cardiol 1998;31:512–8.
19. 19. Sorajja P, Gersh BJ, Mehran R, Lansky AJ, Krucoff MW, Webb J et al. Impact of collateral flow on myocardial reperfusion and infarct size in patients undergoing primary angioplasty for acute myocardial infarction. Am Heart J 2007;154(2):379–84.
20. 20. Waldecker B, Waas W, Haberbosch W, Voss R, Wiecha J, Tillmanns H. Prevalence and significance of coronary collateral circulation in patients with acute myocardial infarct. Z Kardiol 2002;91:243–8.
21. 21. Desch S, de Waha S, Eitel I, Koch A, Gutberlet M, Schuler G et al. Effect of coronary collaterals on long-term prognosis in patients undergoing primary angioplasty for acute ST-elevation myocardial infarction. Am J Cardiol 2010;106(5):605–11.
22. 22. Steg PG, Kerner A, Mancini GB, Reynolds HR, Carvalho AC, Fridrich V et al; OAT Investigators. Impact of collateral flow to the occluded infarct-related artery on clinical outcomes in patients with recent myocardial infarction: a report from the randomized occluded artery trial. Circulation 2010;121:2724–30.
23. 23. Tron C, Donohue TJ, Bach RG, Watford T, Caracciolo EA, Aquirre VF et al. Differential characterization of human coronary collateral blood flow velocity. Am Heart J 1996;132:508–15.
24. 24. Yamada T, Okamoto M, Sueda T, Hashimoto M, Kajiyama G. Relation between collateral flow assessed by Doppler guide wire and angiographic collateral grades. Am Heart J 1995;130:32–7.
25. 25. Seiler C, Fleisch M, Garachemani A, Meier B. Coronary collateral quantitation inpatients with coronary artery disease using intravascular flow velocity or pressuremeasurements. J Am Coll Cardiol 1998;32:1272–9.
26. 26. de Marchi SF, Gloekler S, Meier P, Traupe T, Steck H, Cook S et al. Determinants of preformed collateral vesselsin the human heart without coronary artery disease. Cardiol 2011;118:198–206.