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Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era: a prospective observational study.
- Source :
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BMJ open [BMJ Open] 2016 Jul 13; Vol. 6 (7), pp. e011105. Date of Electronic Publication: 2016 Jul 13. - Publication Year :
- 2016
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Abstract
- Objectives: To evaluate the short-term and long-term prognostic impacts of acute phase coronary collaterals to occluded infarct-related arteries (IRA) after ST-elevation myocardial infarction (STEMI) in the percutaneous coronary intervention (PCI) era.<br />Design: A prospective observational study.<br />Setting: Osaka Acute Coronary Insufficiency Study (OACIS) in Japan.<br />Participants: 3340 patients with STEMI from the OACIS database who were admitted to hospitals within 24 hours from the onset and who had a completely occluded IRA.<br />Interventions: Patients were divided into 4 groups according to the Rentrop collateral score (RCS) by angiography on admission (RCS-0, no visible collaterals; RCS-1, collaterals without IRA filling; RCS-2, collaterals with partial IRA filling; and RCS-3, collaterals with complete IRA filling).<br />Primary Outcome Measures: In-hospital and 5-year mortality.<br />Results: Patients with RCS-0/3 were older than patients with RCS-1/2, and the prevalence of previous myocardial infarction was highest in patients with RCS-3. Median peak creatinine phosphokinase levels decreased as RCS increases (p<0.001), suggesting the acute cardioprotective effects of collaterals. Although RCS-1 and RCS-2 collaterals were associated with better in-hospital mortality (adjusted OR 0.48, p=0.046 and 0.38, p=0.010 for RCS-1 and RCS-2, respectively) and 5-year mortality (adjusted HR 0.53, p=0.004 and 0.46, p<0.001 for RCS-1 and RCS-2, respectively) as compared with R-0, presence of RCS-3 collaterals was not associated with improved in-hospital (adjusted OR 1.35, p=0.331) and 5-year mortality (adjusted HR 0.98, p=0.920), possibly because worse clinical profiles in patients with RCS-3 may mask mortality benefit of coronary collaterals.<br />Conclusions: Presence of acute phase coronary collaterals such as RCS-1 and RCS-2 were associated with better in-hospital and 5-year mortality after STEMI in the contemporary PCI era.<br /> (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)
- Subjects :
- Arrhythmias, Cardiac
Coronary Occlusion
Electrocardiography
Female
Heart physiopathology
Hospitalization
Humans
Japan
Male
Middle Aged
Myocardial Infarction pathology
Myocardial Infarction therapy
Prospective Studies
Risk Factors
Blood Vessels
Coronary Circulation
Coronary Vessels pathology
Hospital Mortality
Myocardial Infarction mortality
Percutaneous Coronary Intervention
Subjects
Details
- Language :
- English
- ISSN :
- 2044-6055
- Volume :
- 6
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- BMJ open
- Publication Type :
- Academic Journal
- Accession number :
- 27412101
- Full Text :
- https://doi.org/10.1136/bmjopen-2016-011105