title: Determination of the severity of underlying lesions in acute myocardial infarction on the basis of collateral vessel development.
abstract: BACKGROUND
  We aimed to address the conflict over whether the underlying lesion that leads to acute myocardial infarction (AMI) is representative of low-grade or high-grade stenosis. Because the development of collateral vessels is an indication of ischemia, their presence was used as a surrogate marker for the existence of a high-grade lesion.
  
  
  METHODS
  Coronary angiography was used to assess 159 patients, divided into two groups, with (Rentrop 1-3) and without (Rentrop 0) collateral vessels, who had AMI with ST-segment elevation for which they underwent a percutaneous coronary intervention with the implantation of a coronary stent and had baseline thrombolysis in myocardial infarction 0/1 flow.
  
  
  RESULTS
  Of the 159 patients recruited, the presence of collateral vessels was detected in 95 (collateral group; 60%), indicating that the causal lesion was representative of a high-grade stenosis. Among these 95 patients, the Rentrop scores were 1, 2, and 3 in 57 (60%), 33 (34.7%), and six (5.3%) patients, respectively. Logistic regression analysis showed that a baseline thrombolysis in myocardial infarction 0 flow (hazard ratio, 4.6; 95% confidence interval, 1.4-14.6; P=0.01) and a culprit right coronary artery (hazard ratio, 3.0; 95% confidence interval, 1.4-6.2; P=0.007) were independent predictors of the development of collateral vessels.
  
  
  CONCLUSIONS
  The majority of AMI cases can be attributed to a severe stenosis, as demonstrated by the presence of collateral vessels in 60% of the patients in this study.
authors.affiliation: aDepartment of Cardiology, National University Heart Centre bBiostatistics Unit, National University Health System cDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Khoo
authors.forename: Liang
authors.initials: L
authors.lastname: Shen
authors.forename: Liangping
authors.initials: L
authors.lastname: Zhao
authors.forename: Valerie
authors.initials: V
authors.lastname: Khoo
authors.forename: Germaine
authors.initials: G
authors.lastname: Loo
authors.forename: Authur M
authors.initials: AM
authors.lastname: Richards
authors.forename: Tiong-Cheng
authors.initials: TC
authors.lastname: Yeo
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Lee
mesh_terms: D016009:Chi-Square Distribution; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome