Early infarct artery collateral flow does not improve long-term survival following thrombolytic therapy for acute myocardial infarction

Nicolau, José Carlos; Nogueira, Paulo Roberto; Pinto, Maria Auxiliadora Ferraz Vieira; Serrano, Carlos; Garzon, S.A.C.

doi:10.1016/s0002-9149(98)00776-0

Cited by 59 publications

(42 citation statements)

References 22 publications

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“…Saito et al [6], Rentrop et al [24] and Habib et al [11] reported beneficial effects of collateral vessels in such cases. Gohlke et al [9] and Nicolau et al [19] however reported that the presence of collateral vessels did not protect against long-term adverse effects in patients with AMI. But as mentioned above, these studies heretofore limited by the methods used to assess the collateral circulation.…”

Section: Discussionmentioning

confidence: 97%

The relationship between collateral blood flow and infarct zone regional wall motion in patients with recent acute myocardial infarction

Sezer¹,

Nişancí²,

Umman³

et al. 2011

Int J Angiol

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After acute myocardial infarction (AMI), the most significant prognostic determinants of myocardial viability and function are deterioration degree of the distal myocardial microcirculation and collateral flow. Quantification of coronary collateral circulation is possible by using intracoronary pressure measurement techniques. We hypothesized that quantitatively determined coronary wedge pressure (CWP) and collateral flow index (CFI) may be useful in order to designate regional left ventricular function and indirectly viability after MI. In this study, we investigated the relationships between angiographically quantified wall motion scores and CWP and CFI in patients with recent AMI and treated with thrombolytic therapy. Forty patients early after myocardial infarction with 60% residual stenosis in infarct related artery (IRA) after thrombolysis, who underwent PTCA and/or stent implantation for this culprit lesion, were included in this study. None of the patients had significant stenosis in other coronary arteries. Angiographic ventricular wall motion scoring (WMS) was performed semi quantitatively according to coronary artery surgery study criteria. After angiography, fiberoptic pressure monitoring guide wire (pressure wire, Radi) was positioned distal to the stenosis to be dilated. During complete occlusion with balloon inflation distal pressure recorded as CWP. CFI was determined as the ratio of simultaneously measured CWP to aortic pressure. The mean values of CWP, CFI and mean WMS were 18.1 ± 7.9 mmHg, 0.18 ± 0.09 and 3.15 ± 0.8, respectively. The CWP (r: )0.86) and CFI (r: )0.84) values correlated well with WMS determined in the infarcted territory. We concluded that collateral circulation in the infarcted region is related to the left ventricular regional function. Presence of adequate and intact collateral network in the infarct related segments diminishes microvascular damage translating into preserved left ventricular regional functions.

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Section: Discussionmentioning

confidence: 97%

The relationship between collateral blood flow and infarct zone regional wall motion in patients with recent acute myocardial infarction

Sezer¹,

Nişancí²,

Umman³

et al. 2011

Int J Angiol

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“…The relative risk for mortality from any cause in these studies among patients with spontaneously visible collateral arteries has been reduced to 0.47 (95% confidence interval 0.25-0.87) in the former and to 0.72 (95% confidence interval 0.49-1.06) in the latter investigation, respectively ( Figure 5). 50,[52][53][54][55][56][57][58][59][60][61][62] The fact that in the study by Steg et al 53 angiographic collaterals were only marginally beneficial on all-cause mortality is directly related to the inclusion of about half the patients in this subacute infarction population with delayed arteriogenesis occurring only after the myocardial-salvaging window of the 1st 3 to 6 hours after symptom onset.…”

Section: Impact Of the Collateral Circulation On Outcomementioning

confidence: 99%

Assessment and Impact of the Human Coronary Collateral Circulation on Myocardial Ischemia and Outcome

Seiler

2013

Circ: Cardiovascular Interventions

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Appropriate for risk stratification and clinical studies ACS indicates acute coronary syndrome; AP, angina pectoris; CFI p , pressure-derived collateral flow index; CFI v , velocity-derived collateral flow index; CPI, collateral perfusion index; CTO, chronic total (coronary) occlusion; and LV, left ventricle. threshold of 11 heartbeats accurately distinguishes between collateral supply sufficient or insufficient to prevent myocardial ischemia during a brief occlusion (sensitivity of 88%, specificity of 81% 28 ; Table 2). Quantitative Coronary Pressure and Doppler Sensor MeasurementsIn addition to their principle angiographic results, Rentrop et al 27 first described an angioplasty balloon occlusion model using the ratio between distal coronary occlusive or wedge pressure (P occl ) and aortic pressure (P ao ), which correlates with angiographic collateral score groups in patients with 1-vessel CAD (Table 2). 29 In 1987, Meier et al 30 found that a P occl ≥30 mm Hg accurately predicted the presence of spontaneously visible or recruitable collaterals. However, P occl is not dependent only on the amount of collateral flow to the occluded vascular region. Determinants of P occl are the driving pressure across collateral pathways (ie, the pressure difference between the coronary pressure in the collateral supplying and receiving artery), the venous back pressure (central venous or right atrial pressure), but also extravascular pressure related to compression of intramural vessels by cardiac contraction and to transmission of diastolic LV pressure to the epicardial circulation. 31 In this context, in that of microembolization of the collateral-dependent vascular area, P occl should not be used for collateral assessment in the acute coronary syndrome because collateral function is substantially overestimated. In the setting of chronic CAD, LV filling pressure has, however, no influence on P occl unless it exceeds values of 30 mm Hg.In 1993, Pijls et al 32 provided the experimental basis for the determination of maximum coronary and myocardial fractional blood flow by coronary pressure measurements; importantly, the contribution to myocardial blood flow by collateral pathways was assumed negligible. In this study, microvascular resistance during pharmacologically induced hyperemia was postulated to be constant and minimal and, thus, no longer dependent on the degree of epicardial stenoses. As a consequence, coronary pressure should directly reflect coronary flow, the former of which is more easily obtainable during invasive examination than the latter. Therefore, myocardial flow Q distal to a stenosis (the sum of flow through the stenotic vessel plus collateral flow as assumed to be zero) relative to myocardial flow without the stenosis Q N (Q/ Q N =fractional flow reserve, FFR) could be calculated on the basis of distal coronary pressure and aortic pressure both after subtraction of central venous backpressure (CVP). The model was tested in dogs, whereby Doppler-derived measurements of stenotic coronary flow Q s to norm...

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“…Currently available data in these patient groups have so far failed to demonstrate a beneficial effect of collateral circulation [16][17][18][19]. One explanation for such findings may be that the benefit exerted by collaterals was obscured by the harm from extensive atherosclerotic burden.…”

Section: Prognostic Effect Of Coronary Collaterals May Be Altered By mentioning

confidence: 99%

Coronary collaterals—insights in molecular determinants and prognostic relevance

Regieli¹,

Nathoe²,

Koerselman³

et al. 2007

International Journal of Cardiology

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Early infarct artery collateral flow does not improve long-term survival following thrombolytic therapy for acute myocardial infarction

Cited by 59 publications

References 22 publications

The relationship between collateral blood flow and infarct zone regional wall motion in patients with recent acute myocardial infarction

The relationship between collateral blood flow and infarct zone regional wall motion in patients with recent acute myocardial infarction

Assessment and Impact of the Human Coronary Collateral Circulation on Myocardial Ischemia and Outcome

Coronary collaterals—insights in molecular determinants and prognostic relevance

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