Prognostic implications of the rapid recruitment of coronary collaterals during ST elevation myocardial infarction (STEMI): a meta-analysis of over 14,000 patients

Allahwala, U.; Nour, Daniel; Alsanjari, Osama; Bhatia, Kunwardeep; Nagaraja, Vinayak; Khatri, Jaikirshan; Cockburn, James; Hildick‐Smith, David; Sakata, Yasuhiko; Ward, Michael R.; Weaver, James; Bhindi, Ravinay

doi:10.1007/s11239-020-02282-6

Cited by 9 publications

(9 citation statements)

References 32 publications

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“…While the magnitude of collateral perfusion has not previously been known, having robust coronary collateral circulation as visualized by invasive angiography has been associated with clinical benefits, since robust collaterals allow oxygenated blood to reach the jeopardized myocardium [1]. Patients with robust collaterals presenting with ST elevation myocardial infarction have a lower mortality in both the short and long term, and have a higher left ventricular ejection fraction [1]. Furthermore, patients with robust collaterals are more likely to 9 have successful percutaneous coronary intervention to treat chronic total occlusion [13].…”

Section: Discussionmentioning

confidence: 99%

“…Having robust coronary collateral circulation as visualized by invasive angiography has been associated with clinical benefits, since robust collaterals allow oxygenated blood to reach the jeopardized myocardium [2, 3, 20]. Patients with robust collaterals presenting with STEMI have a lower mortality in both the short and long term, and higher left ventricular ejection fraction [3].…”

Section: Discussionmentioning

confidence: 99%

“…The coronary collateral circulation is a preformed network of anastomotic connections between primitive vessels, linking one epicardial artery with another, acting as a "natural bypass" mechanism. The presence of robust coronary collateral circulation is known to be associated with improved survival and left ventricular function in the setting of ST-elevation myocardial infarction [1]. Whilst the prevalence of collaterals varies between species, approximately 25% of patients have angiographically visible robust collaterals at the time of ST elevation myocardial infarction [2].…”

Section: Introductionmentioning

confidence: 99%

“…The coronary collateral circulation is a preformed network of anastomotic connections between primitive vessels, linking one epicardial artery with another, acting as a “natural bypass” mechanism [1, 2]. The presence of robust coronary collateral circulation is known to be associated with improved survival and left ventricular function in the setting of ST-elevation myocardial infarction (STEMI) [3].…”

Section: Introductionmentioning

confidence: 99%

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Immediate recruitment of dormant coronary collaterals can provide more than half of normal resting perfusion during coronary occlusion in patients with coronary artery disease

Harris

Warren

Persson

et al. 2021

Preprint

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Background: There is sufficient collateral flow to prevent myocardial ischemia during balloon occlusion in approximately one in five patients. However, the magnitude of myocardial perfusion provided by the coronary collateral circulation during occlusion is unknown. Therefore, the aim of this study was to quantify collateral myocardial perfusion during balloon occlusion in patients with coronary artery disease (CAD). Methods: Patients without angiographically visible collaterals undergoing elective percutaneous transluminal coronary angioplasty (PTCA) to a single epicardial vessel underwent two scans with 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT). All subjects underwent at least three minutes of angiographically verified complete balloon occlusion, at which time an intravenous injection of the radiotracer was administered, followed by SPECT imaging. A second radiotracer injection followed by SPECT imaging was performed 24 hours after PTCA. Results: The study included 21 patients (median [interquartile range] age 70 [56-74] years, 48% female). The diameter stenosis ranged from 60-99%, with successful PTCA performed with a mean 5-minute balloon occlusion. The perfusion defect extent was 16 [8-30]% of the LV. The collateral perfusion at rest was 64 [58-68]% of normal perfusion. Collateral perfusion was negatively correlated with perfusion defect size (R2=0.85, p<0.001), and did not differ by sex (p=0.27) or age (p=0.58). Conclusions: This is the first study to describe the magnitude of coronary microvascular collateral perfusion in patients with CAD. On average, despite coronary occlusion and an absence of angiographically visible collateral vessels, collaterals provide approximately 60% of the perfusion that reaches the jeopardized myocardium during coronary occlusion.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Immediate recruitment of dormant coronary collaterals can provide more than half of normal resting perfusion during coronary occlusion in patients with coronary artery disease

Harris

Warren

Persson

et al. 2021

Preprint

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“… 1 , 2 The presence of robust coronary collateral circulation is known to be associated with improved survival and left ventricular function in the setting of ST-elevation myocardial infarction (STEMI). 3 …”

Section: Introductionmentioning

confidence: 99%

Immediate recruitment of dormant coronary collaterals can provide more than half of normal resting perfusion during coronary occlusion in patients with coronary artery disease

Reid

Lindow

Warren

et al. 2023

Journal of Nuclear Cardiology

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Background Dormant coronary collaterals are highly prevalent and clinically beneficial in cases of coronary occlusion. However, the magnitude of myocardial perfusion provided by immediate coronary collateral recruitment during acute occlusion is unknown. We aimed to quantify collateral myocardial perfusion during balloon occlusion in patients with coronary artery disease (CAD). Methods Patients without angiographically visible collaterals undergoing elective percutaneous transluminal coronary angioplasty (PTCA) to a single epicardial vessel underwent two scans with 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT). All subjects underwent at least three minutes of angiographically verified complete balloon occlusion, at which time an intravenous injection of the radiotracer was administered, followed by SPECT imaging. A second radiotracer injection followed by SPECT imaging was performed 24 h after PTCA. Results The study included 22 patients (median [interquartile range] age 68 [54-72] years. The perfusion defect extent was 19 [11-38] % of the LV, and the collateral perfusion at rest was 64 [58-67]% of normal. Conclusion This is the first study to describe the magnitude of short-term changes in coronary microvascular collateral perfusion in patients with CAD. On average, despite coronary occlusion and an absence of angiographically visible collateral vessels, collaterals provided more than half of the normal perfusion.

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Clinical Cases of Electrosonography in Patients with Acute Chest Pain

Koslowsky,

Elitzur,

Leibowitz

et al. 2023

Cardiac Electrosonography

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Prognostic implications of the rapid recruitment of coronary collaterals during ST elevation myocardial infarction (STEMI): a meta-analysis of over 14,000 patients

Cited by 9 publications

References 32 publications

Immediate recruitment of dormant coronary collaterals can provide more than half of normal resting perfusion during coronary occlusion in patients with coronary artery disease

Immediate recruitment of dormant coronary collaterals can provide more than half of normal resting perfusion during coronary occlusion in patients with coronary artery disease

Immediate recruitment of dormant coronary collaterals can provide more than half of normal resting perfusion during coronary occlusion in patients with coronary artery disease

Clinical Cases of Electrosonography in Patients with Acute Chest Pain

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