Heart Center Leipzig, Department of Internal Medicine/Cardiology, University of Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
Clin Res Cardiol. 2020 Oct;109(10):1307-1315. doi: 10.1007/s00392-020-01625-w. Epub 2020 Mar 13.
The role of coronary collaterals in ST-elevation myocardial infarction (STEMI) remains controversial. So far, studies examining the effect of collaterals on outcome mainly focused on patients presenting early after symptom onset. We sought to investigate the prognostic influence of coronary collateralization in patients presenting with prolonged ischemia late after symptom onset.
The study is a subanalysis of a randomized trial addressing thrombus aspiration in STEMI patients presenting between 12 and 48 h after symptom onset with a follow-up period of a minimum of 4 years. A total of 95 patients with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 0 or 1 prior to percutaneous coronary intervention (PCI) were included in the analysis. Of these, 62 patients (65%) had none or poor coronary collateralization according to the Rentrop classification (Rentrop grade 0 or 1) compared to 33 (35%) with well-developed collateralization (Rentrop grade 2 or 3). In comparison, patients with well-developed collateralization had a smaller area of microvascular obstruction (2.1 ± 3.8 vs. 4.5 ± 4.9% of left ventriclular mass (%LV), p = 0.03) and infarct size (27.9 ± 11.7 vs. 34.8 ± 17.2% LV, p = 0.047) on magnetic resonance imaging. Further, mortality at 4-years follow-up was lower (6% Rentrop grade 2 or 3 vs. 25% Rentrop grade 0 or 1, p = 0.02). Poor collateralization was an independent predictor of long-term mortality on multivariate Cox regression analyses in addition to cardiogenic shock and unsuccessful PCI during the index procedure.
Sufficient coronary collateralization has a positive impact on microvascular obstruction, infarct size and long-term mortality in STEMI patients presenting between 12 and 48 h after symptom onset.
在 ST 段抬高型心肌梗死（STEMI）中，侧支循环的作用仍存在争议。到目前为止，研究主要集中在症状发作后早期评估侧支循环对预后的影响。我们旨在探讨在症状发作后长时间缺血的患者中侧支循环对预后的影响。
本研究是一项随机试验的亚组分析，该试验针对症状发作后 12-48 小时内接受经皮冠状动脉介入治疗（PCI）的 STEMI 患者进行血栓抽吸治疗，随访时间至少 4 年。共纳入 95 例 PCI 前 TIMI 血流分级 0 或 1 的患者进行分析。其中，62 例（65%）根据Rentrop 分级（Rentrop 0 或 1 级）表现为无侧支循环或侧支循环不良，而 33 例（35%）侧支循环良好（Rentrop 2 或 3 级）。相比之下，侧支循环良好的患者微血管阻塞面积较小（2.1±3.8%左心室质量[LV]与 4.5±4.9%LV，p=0.03）和梗死面积较小（27.9±11.7%LV 与 34.8±17.2%LV，p=0.047）。进一步，在 4 年随访时，死亡率较低（Rentrop 2 或 3 级 6%与 Rentrop 0 或 1 级 25%，p=0.02）。多变量 Cox 回归分析表明，除心源性休克和指数手术中 PCI 失败外，侧支循环不良也是长期死亡率的独立预测因素。
在症状发作后 12-48 小时的 STEMI 患者中，充分的侧支循环对微血管阻塞、梗死面积和长期死亡率有积极影响。
