title: Collateral vessel opacification with CT in patients with coronary total occlusion and its relationship with downstream myocardial infarction.
abstract: OBJECTIVE
  To assess the correlation between the filling pattern of distal coronary vessels in patients with chronic total occlusion (CTO) observed at coronary computed tomographic (CT) angiography and the extent of downstream myocardial infarction (MI).
  
  
  METHODS
  All patients gave written informed consent, and the institutional review board approved the study protocol. A total of 97 patients (mean age, 68.5 years ± 11.5 [standard deviation]; age range, 38-87 years; 77 men, 20 women) with 106 CTOs were prospectively enrolled. Distal filling of the epicardial segment was semiquantitatively classified by using a four-point scale according to patterns at coronary CT angiography (0 = absence of distal filling; 1 = partial distal filling, with a length less than one-third of the segment; 2 = partial distal filling, with a length between one-third and two-thirds of the segment; 3 = complete or partial distal filling, with a length longer than two-thirds of the segment). A coronary CT angiography score of 3 was considered indicative of well-developed collaterals. Downstream MI transmurality and wall motion abnormality were verified semiquantitatively with cardiac magnetic resonance imaging. Mann-Whitney U test and t test were used for comparison.
  
  
  RESULTS
  Coronary CT angiography revealed three lesions with a score of 0, 21 with a score of 1, 35 with a score of 2, and 47 with a score of 3. The non-MI subgroup was associated with higher collateral grading at CT angiography, whereas the transmural MI subgroup was associated with lower collateral grading (P = .005). When compared with the poorly developed (score 0-2) collaterals group, the well-developed (score 3) collateral group correlated to a lower summed transmurality score (P < .001) and a lower summed regional wall motion abnormality score (P = .029).
  
  
  CONCLUSIONS
  The presence of well-developed distal collaterals as revealed by coronary CT angiography in patients with CTO lesions correlates with the lower frequency and extent of downstream MI.
authors.affiliation: From the Departments of Radiology (J.Z., Y.L., M.L.) and Cardiology (J.P., Z.L.), Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Rd, Shanghai 200233, China.
authors.forename: Jiayin
authors.initials: J
authors.lastname: Zhang
authors.forename: Yuehua
authors.initials: Y
authors.lastname: Li
authors.forename: Minghua
authors.initials: M
authors.lastname: Li
authors.forename: Jingwei
authors.initials: J
authors.lastname: Pan
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods; D003097:Collateral Circulation; D003287:Contrast Media; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007479:Iopamidol; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D010347:Patient Care Planning; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007479:Iopamidol