Impact of Coronary Collaterals on Long-term Prognosis in Patients Treated With Primary Angioplasty.
OBJECTIVE
The beneficial effect of coronary collateral circulation (CC) in patients with ST-segment elevation myocardial infarction is controversial. The aim of this study was to evaluate the impact of CC before reperfusion with primary angioplasty (PA) on the long-term prognosis of these patients.


METHODS
Retrospective observational study of a cohort of 947 patients treated with PA and TIMI grade ≤ 1 flow in a single center from 2005 to 2013. Propensity score matching was used to create 2 groups of 175 patients each, matched by the degree of CC (Rentrop 0-1 vs Rentrop 2-3). In the matched cohort, we determined the impact of CC on total mortality, cardiovascular mortality, and a combined adverse cardiovascular event endpoint for a median follow-up of 864 (interquartile range, 396-1271) days.


RESULTS
Of a total of 947 patients included, 735 (78%) had Rentrop 0 to 1 and 212 (22%) had Rentrop 2 to 3. During follow-up, 105 patients died, 71 from cardiovascular causes. In the matched cohort, the total mortality rate was similar between the 2 groups (Rentrop 0-1 [8.8%] vs Rentrop 2-3 [6.3%]; HR = 1.22; 95%CI, 0.50-2.94; P = .654). There were no differences in cardiovascular mortality (Rentrop 0-1 [4.6%] vs Rentrop 2-3 [2.3%]; sHR = 0.49; 95%CI, 0.14-1.62; P = .244) or the composite endpoint including cardiovascular death, reinfarction, target vessel revascularization, and coronary artery bypass surgery (Rentrop 0-1 [18.8%] vs Rentrop 2-3 [13.1%]; sHR = 0.68; 95%CI, 0.40-1.15; P = .157).


CONCLUSIONS
In this contemporary series, the presence of good CC before PA was not associated with better long-term clinical outcomes.
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. Electronic address: fhernandezcar@gmail.com.
Francisco José
FJ
Hernández-Pérez
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Josebe
J
Goirigolzarri-Artaza
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
María Alejandra
MA
Restrepo-Córdoba
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Arturo
A
García-Touchard
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Juan Francisco
JF
Oteo-Domínguez
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Lorenzo
L
Silva-Melchor
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
José Antonio
JA
Fernández-Díaz
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
José Ramón
JR
Domínguez-Puente
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Luis
L
Alonso-Pulpón
Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
Javier
J
Goicolea-Ruigómez
D000359:Aftercare; D000925:Anticoagulants / Q000627:therapeutic use; D003097:Collateral Circulation / Q000502:physiology*; D017023:Coronary Angiography / Q000401:mortality / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D003326:Coronary Circulation / Q000502:physiology*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000401:mortality / Q000706:statistics & numerical data; D015588:Observer Variation; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D057216:Propensity Score; D012008:Recurrence; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013030:Spain / Q000453:epidemiology
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors
Angioplastia coronaria; Circulación colateral; Collateral circulation; Coronary angioplasty; Infarto de miocardio; Myocardial infarction; Supervivencia; Survival