title: Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era: a prospective observational study.
abstract: To evaluate the short-term and long-term prognostic impacts of acute phase coronary collaterals to occluded infarct-related arteries (IRA) after ST-elevation myocardial infarction (STEMI) in the percutaneous coronary intervention (PCI) era.
  
  
  
  A prospective observational study.
  
  
  
  Osaka Acute Coronary Insufficiency Study (OACIS) in Japan.
  
  
  
  3340 patients with STEMI from the OACIS database who were admitted to hospitals within 24 hours from the onset and who had a completely occluded IRA.
  
  
  
  Patients were divided into 4 groups according to the Rentrop collateral score (RCS) by angiography on admission (RCS-0, no visible collaterals; RCS-1, collaterals without IRA filling; RCS-2, collaterals with partial IRA filling; and RCS-3, collaterals with complete IRA filling).
  
  
  
  In-hospital and 5-year mortality.
  
  
  
  Patients with RCS-0/3 were older than patients with RCS-1/2, and the prevalence of previous myocardial infarction was highest in patients with RCS-3. Median peak creatinine phosphokinase levels decreased as RCS increases (p<0.001), suggesting the acute cardioprotective effects of collaterals. Although RCS-1 and RCS-2 collaterals were associated with better in-hospital mortality (adjusted OR 0.48, p=0.046 and 0.38, p=0.010 for RCS-1 and RCS-2, respectively) and 5-year mortality (adjusted HR 0.53, p=0.004 and 0.46, p<0.001 for RCS-1 and RCS-2, respectively) as compared with R-0, presence of RCS-3 collaterals was not associated with improved in-hospital (adjusted OR 1.35, p=0.331) and 5-year mortality (adjusted HR 0.98, p=0.920), possibly because worse clinical profiles in patients with RCS-3 may mask mortality benefit of coronary collaterals.
  
  
  
  Presence of acute phase coronary collaterals such as RCS-1 and RCS-2 were associated with better in-hospital and 5-year mortality after STEMI in the contemporary PCI era.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Suita, Japan Department of Medical Innovation, Osaka University Hospital, Suita, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hara
authors.affiliation: Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sakata
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Daisaku
authors.initials: D
authors.lastname: Nakatani
authors.affiliation: Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Suna
authors.affiliation: Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Nishino
authors.affiliation: School of Human Welfare Studies, Kwansei Gakuin University, Nishinomiya, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.affiliation: Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nanto
authors.affiliation: Osaka Prefectural Hospital Organization Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Hori
authors.affiliation: Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D001145:Arrhythmias, Cardiac; D001808:Blood Vessels; D003326:Coronary Circulation; D054059:Coronary Occlusion; D003331:Coronary Vessels / Q000473:pathology*; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D012307:Risk Factors
keywords: Coronary collateral; Mortality; Percutaneous coronary intervention; ST-elevation myocardial infarction