[Prevalence and significance of coronary collateral circulation in patients with acute myocardial infarct].
Angiograms from consecutive and unselected patients with acute myocardial infarction were studied with respect to the prevalence as well as the significance of coronary collateral circulation to myocardium distal to the acute coronary occlusion.


METHODS
Coronary angiograms were obtained from 700 consecutive and unselected patients with an acute transmural infarction within 3.7 +/- 3 hours (0.5-12) of symptom onset. No patient had undergone i.v. thrombolysis prior to angiography. Complete and acute vessel occlusion was found in 626/700 patients (89%). Coronary collaterals were detected and graded using Rentrop's classification. The grade of collateral circulation was related to the clinical course after 30 days and to the global and regional left ventricular wall motion.


RESULTS
Collaterals were found in 334 patients (69%); 242 patients (38%) had collateral flow grade 2 or 3. Collaterals were demonstrated more frequently in women vs men and in patients with multivessel disease. The prevalence of collaterals was unrelated to age and the presence of diabetes mellitus. Patients who had angiography within 3 hours of symptom onset had collaterals detected less frequently than patients who had angiography beyond 6 hours (66% vs 75%, p < 0.05). No collaterals were found in 17/37 patients (47%) in cardiogenic shock and inferior MI but in only 30/164 patients (18%, p < 0.01) without shock. Global and regional left ventricular wall motion after 2 weeks was unrelated to the degree of coronary collateral circulation during acute myocardial infarction.


CONCLUSIONS
Collateral circulation to myocardium distal to an acutely occluded coronary artery is detected in 2/3 patients during the acute infarct phase. The absence of collaterals is related to the early occurrence of cardiogenic shock in patients with inferior MI but not to the presence of diabetes mellitus. After direct angioplasty of the infarct vessel, the protective effects of coronary collaterals on chronic LV function remain uncertain.
Waldecker
B
B
Medizinische Klinik I Zentrum Innere Medizin Justus-Liebig-Universität Klinikstr. 36, 35392 Giessen, Germany. Bernd.Waldecker@innere.med.uni-giessen.de
Waas
W
W
Haberbosch
W
W
Voss
R
R
Wiecha
J
J
Tillmanns
H
H
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left / Q000502:physiology