The role of antegrade and collateral flow in relation to left ventricular function post-thrombolysis

Nicolau, José Carlos; Pinto, Maria Auxiliadora Ferraz Vieira; Nogueira, Paulo Roberto; Lorga, Adalberto Menezes; Jacob, J L; Garzon, S.A.C.

doi:10.1016/s0167-5273(97)00134-4

Cited by 6 publications

(6 citation statements)

References 32 publications

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“…On one hand, it is reasonable to speculate that coronary collateral development has positive effect on clinical outcomes, since the presence of good coronary collaterals could reduce infarct size, improve myocardial salvage, preserve left ventricular function, and prevent ventricular aneurysm formation in patients with STEMI. 3,5,7,8 Furthermore, coronary collaterals are associated with a decreased incidence of ventricular arrhythmias due to an ischemia-induced prolongation of the QT interval. 31 On the other hand, however, high coronary collaterals may be a marker of more advanced coronary artery disease, which could imply a poorer long-term prognosis.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…1,2 In patients with ST-segment elevation myocardial infarction (STEMI), the presence of angiographic coronary collaterals might be associated with a smaller infarct size, less extensive microvascular injury, higher residual ejection fraction, decreased incidence of mechanical complications, and a longer reperfusion time with buffer. [3][4][5][6][7][8] Nonetheless, the impact of coronary collaterals on clinical outcomes, especially mortality in patients with STEMI, in the era of coronary revascularization, remains unproven. Current trials have shown conflicting results: Some reported improved survival in patients with angiographic collaterals, whereas others reported no improvement in prognosis relevant to coronary collateral circulation.…”

Section: Introductionmentioning

confidence: 99%

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Effect of Coronary Collaterals on Prognosis in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction: A Meta-Analysis

et al. 2018

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The impact of coronary collaterals on the prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) in the era of coronary revascularization remains controversial. The purpose of this meta-analysis was to investigate the effect of coronary collateral on clinical outcomes, especially mortality (≥6 months), in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. Eligible observational studies were selected by searching PubMed, EMBASE, and Cochrane Library up to August 9, 2017. Overall, 14 observational studies involving 10 411 patients were included. Coronary collaterals were found to reduce the risk of long-term mortality (≥6 months; risk ratio [RR]: 0.65, 95% confidence interval [CI]: 0.55-0.76) as well as in-hospital plus 30-day mortality (RR: 0.61, 95% CI: 0.47-0.78) in patients undergoing PCI for STEMI. In addition, pooling the risk-adjusted or propensity-matched data showed a significant reduction in long-term mortality (RR: 0.68, 95% CI: 0.49-0.95) and in-hospital plus 30-day mortality (RR: 0.27, 95% CI: 0.13-0.55) in patients with collateral circulation. However, no significant difference was found in the risk of recurrent myocardial infarction and target vessel revascularization between the 2 groups. Therefore, it was found that coronary collaterals have a beneficial effect on long-term survival (≥6 months) as well as in-hospital plus 30-day survival in patients undergoing primary PCI for STEMI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect of Coronary Collaterals on Prognosis in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction: A Meta-Analysis

et al. 2018

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“…The preservation of myocardium from the reduced infarct area, ensures higher residual cardiac function (left ventricular ejection fraction) – which is a great prognostic indicator [ 48 ].…”

Section: Clinical Importance Of Coronary Collateral Circulationmentioning

confidence: 99%

Collateral Circulation in Chronic Total Occlusions – an interventional perspective

Choo

2015

CCR

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Human coronary collaterals are inter-coronary communications that are believed to be present from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be assessed by various methods. These coronary collateral channels have been used successfully as a retrograde access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target in patients with no suitable revascularization option is an exciting proposal.

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“…20 Lee et al 21 found that in patients with sufficient collaterals, left ventricular recovery after reperfused myocardial infarction is primarily determined by the amount of collateral blood flow and is less dependent upon the time for reperfusion. Also, the presence of significant collateral flow is associated with a higher postinfarctionejection fraction 22 and decreased aneurysmal dilation.…”

Section: Myocardial Viability and Collateral Circulationmentioning

confidence: 99%

Myocardial Perfusion in Patients With a Totally Occluded Left Anterior Descending Coronary Artery Reinjected by a Normal Right Coronary Artery: The Role of Collateral Circulation

et al. 2008

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In this article, myocardial perfusion in patients with a totally occluded left anterior descending artery reinjected by a normal right coronary artery is assessed using stress single photon emission computed tomography (SPECT). In all, 20 patients, with a totally occluded left anterior descending artery reinjected by normal right coronary artery, underwent myocardial single photon emission computed tomography imaging within 60 days of angiography. All patients had abnormal perfusion single photon emission computed tomography results and 70% had reversible defects. Perfusion defects at rest were present in 75% of patients, with perinecrotic residual ischemia in 45% of patients whereas for 30% of patients, no viable myocardium was detected in the collateral-dependent segments. In all, 25% of patients had no resting perfusion defects but all are presented with stress-induced ischemia. Collaterals are not protective against stress-induced ischemia, but they can preserve myocardial viability. This conclusion is highly supported by the presence of residual ischemia in the collateral-dependent segments.

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The role of antegrade and collateral flow in relation to left ventricular function post-thrombolysis

Cited by 6 publications

References 32 publications

Effect of Coronary Collaterals on Prognosis in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction: A Meta-Analysis

Effect of Coronary Collaterals on Prognosis in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction: A Meta-Analysis

Collateral Circulation in Chronic Total Occlusions – an interventional perspective

Myocardial Perfusion in Patients With a Totally Occluded Left Anterior Descending Coronary Artery Reinjected by a Normal Right Coronary Artery: The Role of Collateral Circulation

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