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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:178-85 - Vol. 70 Num.03 DOI: 10.1016/j.rec.2016.09.023

Impact of Coronary Collaterals on Long-term Prognosis in Patients Treated With Primary Angioplasty

Francisco José Hernández-Pérez a,, Josebe Goirigolzarri-Artaza a, María Alejandra Restrepo-Córdoba a, Arturo García-Touchard a, Juan Francisco Oteo-Domínguez a, Lorenzo Silva-Melchor a, José Antonio Fernández-Díaz a, José Ramón Domínguez-Puente a, Luis Alonso-Pulpón a, Javier Goicolea-Ruigómez a

a Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain

Keywords

Coronary angioplasty. Collateral circulation. Myocardial infarction. Survival.

Abstract

Introduction and objectives

The beneficial effect of coronary collateral circulation (CC) in patients with ST-segment elevation myocardial infarction is controversial. The aim of this study was to evaluate the impact of CC before reperfusion with primary angioplasty (PA) on the long-term prognosis of these patients.

Methods

Retrospective observational study of a cohort of 947 patients treated with PA and TIMI grade ≤ 1 flow in a single center from 2005 to 2013. Propensity score matching was used to create 2 groups of 175 patients each, matched by the degree of CC (Rentrop 0-1 vs Rentrop 2-3). In the matched cohort, we determined the impact of CC on total mortality, cardiovascular mortality, and a combined adverse cardiovascular event endpoint for a median follow-up of 864 (interquartile range, 396-1271) days.

Results

Of a total of 947 patients included, 735 (78%) had Rentrop 0 to 1 and 212 (22%) had Rentrop 2 to 3. During follow-up, 105 patients died, 71 from cardiovascular causes. In the matched cohort, the total mortality rate was similar between the 2 groups (Rentrop 0-1 [8.8%] vs Rentrop 2-3 [6.3%]; HR = 1.22; 95%CI, 0.50-2.94; P = .654). There were no differences in cardiovascular mortality (Rentrop 0-1 [4.6%] vs Rentrop 2-3 [2.3%]; sHR = 0.49; 95%CI, 0.14-1.62; P = .244) or the composite endpoint including cardiovascular death, reinfarction, target vessel revascularization, and coronary artery bypass surgery (Rentrop 0-1 [18.8%] vs Rentrop 2-3 [13.1%]; sHR = 0.68; 95%CI, 0.40-1.15; P = .157).

Conclusions

In this contemporary series, the presence of good CC before PA was not associated with better long-term clinical outcomes.

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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved