Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Indian heart journal Pub Date : 2024-09-01 DOI:10.1016/j.ihj.2024.10.006
Rajesh Kumar, Naveed Ullah Khan, Ayaz Mir, Khalid Naseeb, Gulzar Ali, Arti Ashok, Mukesh Kumar, Abiha Urooj, Uroosa Safdar, Aisha Hussain, Muhammad Ishaq, Tahir Saghir, Jawaid Akbar Sial, Abdul Hakeem, Musa Karim
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Abstract

Background

Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI).

Methods

The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2–3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course.

Results

In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97–0.99], 1.69 [1.35–2.10], and 3.45 [2.64–4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively.

Conclusion

Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC.
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接受紧急经皮冠状动脉血运重建术的 STE-ACS 患者梗死床袢是否重要?对院内病程前瞻性资料库的评估。
背景:有关冠状动脉袢循环(CCC)在ST段抬高急性冠状动脉综合征(STE-ACS)患者中的作用的数据有限。本研究旨在评估CCC和接受原发性经皮冠状动脉介入治疗(pPCI)的CCC患者的院内病程:研究纳入了连续接受经皮冠状动脉介入治疗的 STE-ACS 患者。良好 CCC 的定义是 Rentrop 侧支评分(RCS)为 2-3。对CCC良好和不良患者的临床特征、血管造影模式和住院过程进行比较:在 4,683 例患者中,平均年龄为 55.6±11 岁,78.8% 为男性。499例(10.7%)患者的CCC良好。术中慢血流/无复流(SF/NR)率为29.9%对20.5%(P结论:STE-ACS患者良好CCC的血管造影证据有限。良好的 CCC 与 MVD 患病率较高、血栓负担较重以及术前 LVEDP 较低有关,导致术中 SF/NR 发生率较高。然而,CCC好和CCC差的患者之间的CACO没有显著差异。
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来源期刊
Indian heart journal
Indian heart journal CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.60
自引率
6.70%
发文量
82
审稿时长
52 days
期刊介绍: Indian Heart Journal (IHJ) is the official peer-reviewed open access journal of Cardiological Society of India and accepts articles for publication from across the globe. The journal aims to promote high quality research and serve as a platform for dissemination of scientific information in cardiology with particular focus on South Asia. The journal aims to publish cutting edge research in the field of clinical as well as non-clinical cardiology - including cardiovascular medicine and surgery. Some of the topics covered are Heart Failure, Coronary Artery Disease, Hypertension, Interventional Cardiology, Cardiac Surgery, Valvular Heart Disease, Pulmonary Hypertension and Infective Endocarditis. IHJ open access invites original research articles, research briefs, perspective, case reports, case vignette, cardiovascular images, cardiovascular graphics, research letters, correspondence, reader forum, and interesting photographs, for publication. IHJ open access also publishes theme-based special issues and abstracts of papers presented at the annual conference of the Cardiological Society of India.
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