title: Frequency of myocardial infarction and its relationship to angiographic collateral flow in territories supplied by chronically occluded coronary arteries.
abstract: BACKGROUND
  Despite complete interruption of antegrade coronary artery flow in the setting of a chronic total occlusion (CTO), clinical recognition of myocardial infarction is often challenging. Using cardiac MRI, we investigated the frequency and extent of myocardial infarction in patients with CTO, and assessed their relationship with regional systolic function and the extent of angiographic collateral flow.
  
  
  RESULTS
  We included 170 consecutive patients (median age, 62 years) with angiographically documented CTO. Regional late gadolinium enhancement and wall motion score index were assessed by cardiac MRI with the use of a 17-segment model. Angiographic collateral flow was assessed by the collateral connection grade and the Rentrop score. Evidence of previous myocardial infarction was found in 25% of patients by ECG Q waves, in 69% by regional wall motion abnormality, and in 86% of patients by late gadolinium enhancement. Increased angiographic collateral flow was associated with a lower frequency of Q waves on ECG, and a lower regional wall motion score index, late gadolinium enhancement volume (%), and degree of late gadolinium enhancement transmurality (all P<0.001), as well.
  
  
  CONCLUSIONS
  The frequency of myocardial infarction in territories subtended by CTO is significantly higher than previously recognized. The degree of myocardial injury downstream epicardial CTO is inversely correlated with the degree of angiographic collaterals.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 35-710, Republic of Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.forename: Sung-A
authors.initials: SA
authors.lastname: Chang
authors.forename: Jin-Oh
authors.initials: JO
authors.lastname: Choi
authors.forename: Young Bin
authors.initials: YB
authors.lastname: Song
authors.forename: Joo-Yong
authors.initials: JY
authors.lastname: Hahn
authors.forename: Seung Hyuk
authors.initials: SH
authors.lastname: Choi
authors.forename: Sang-Chol
authors.initials: SC
authors.lastname: Lee
authors.forename: Sang-Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
authors.forename: Yeonhyeon
authors.initials: Y
authors.lastname: Choe
authors.forename: Hyeon-Cheol
authors.initials: HC
authors.lastname: Gwon
mesh_terms: D000368:Aged; D003097:Collateral Circulation / Q000502:physiology*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D005682:Gadolinium; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000000981:diagnostic imaging; D011859:Radiography
chemical_list: D005682:Gadolinium