title: Determinants of collateral development in patients with acute myocardial infarction.
abstract: BACKGROUND
  The presence or absence of collateral circulation to the infarct-related coronary artery in acute myocardial infarction (AMI) significantly impacts on infarct size and resulting left ventricular function. However, the determinants of collateral development have not been clarified.
  
  
  OBJECTIVE
  The purpose of this study was to elucidate the determinants of collateral development in humans.
  
  
  METHODS
  The study group consisted of 248 patients (178 men, 70 women; mean age 63 years) undergoing coronary angiography within 12 h after the onset of a first AMI. All patients exhibited complete occlusion of the infarct-related artery. The extent of collateral circulation to the area perfused by the infarct-related artery was graded as none, or poorly or well developed, depending on the degree of opacification of the occluded coronary artery on the contralateral injection of contrast.
  
  
  RESULTS
  Well-developed collateral circulation was observed in 92 of the 248 patients (37.1%). The prevalence of well-developed collaterals was 57% in patients with a history of angina pectoris prior to AMI, which was significantly (p < 0.0001) higher than the 26% in those without a history of angina. Multivariate stepwise logistic regression analysis was then applied to identify predictors of collateral development. Possible determinants of collateral development were long-standing preinfarction angina, severity of coronary artery disease, age, gender, and coronary risk factors (hypertension, diabetes, hypercholesterolemia, smoking). This analysis revealed that only the presence of a history of angina pectoris prior to AMI was a significant predictor of collateral development (p < 0.0001).
  
  
  CONCLUSIONS
  A history of angina pectoris prior to AMI is a clinical marker for coronary stenoses. Since severe coronary stenoses can provide stimuli that lead to collateral development, it is reasonable that a history of angina would also be a clinical marker for collateral vessels.
authors.affiliation: College of Medical Technology, Kyoto University, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Fujita
authors.forename: I
authors.initials: I
authors.lastname: Nakae
authors.forename: Y
authors.initials: Y
authors.lastname: Kihara
authors.forename: K
authors.initials: K
authors.lastname: Hasegawa
authors.forename: R
authors.initials: R
authors.lastname: Nohara
authors.forename: K
authors.initials: K
authors.lastname: Ueda
authors.forename: S
authors.initials: S
authors.lastname: Tamaki
authors.forename: K
authors.initials: K
authors.lastname: Otsuka
authors.forename: S
authors.initials: S
authors.lastname: Sasayama
mesh_terms: D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000503:physiopathology; D003097:Collateral Circulation; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000502:physiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012307:Risk Factors; D012737:Sex Factors