title: Collateral filling efficiency of comorbid chronic total occlusion segment on short-term mortality in ST-elevation myocardial infarction.
abstract: BACKGROUND
  Collateral filling of chronic total occlusion (CTO) segments is considered to affect hemodynamic stability in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) with CTO, however its value as a prognostic indicator for mortality is uncertain. The present study examined the relationship between collateral filling of CTO segments and short-term mortality in patients with STEMI with a comorbid CTO lesion.
  
  
  METHODS
  Among 829 STEMI patients who underwent primary PCI, 74 patients with CTO were identified. Collateral filling of their CTO segment was assessed by Rentrop grade (0; n=10, 1; n=13, 2; n=31, 3; n=20) in their initial angiogram and whether the origin of the feeding collateral donor artery was infarct-related artery (IRA) was evaluated using their final angiogram in primary PCI; IRA (n=26) and non-IRA group (n=48). The relationship between these classifications and 30-day all-cause mortality was examined retrospectively.
  
  
  RESULTS
  The 30-day mortalities were 4.5% in single-vessel disease, 18.3% in multi-vessel disease (MVD) without CTO and 25.7% in MVD with CTO. Mortality of MVD with CTO reduced with increasing Rentrop grade from 0 to 3 (80.0%, 30.8%, 19.4%, and 5.0%, respectively). IRA was associated with a significant higher mortality than those of non-IRA (50.0% vs. 12.5%, P=0.0004). Low Rentrop grade 0 or 1 was extracted as an independent predictor of 30-day death (HR 3.28, 95% CI 1.20-9.96, P=0.0203).
  
  
  CONCLUSIONS
  Poor collateral filling of the CTO segment assessed by Rentrop grade was an independent angiographic predictor for 30-day death in patients with STEMI combined with CTO.
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Masataka
authors.initials: M
authors.lastname: Nakano
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Ohno
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Gaku
authors.initials: G
authors.lastname: Nakazawa
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Norihiko
authors.initials: N
authors.lastname: Shinozaki
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsukage
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Fuminobu
authors.initials: F
authors.lastname: Yoshimachi
authors.affiliation: Division of Cardiology, Tokai University School of Medicine, Isehara, Japan. Electronic address: ikari@is.icc.u-tokai.ac.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ikari
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D002908:Chronic Disease; D003097:Collateral Circulation; D003326:Coronary Circulation / Q000502:physiology*; D054059:Coronary Occlusion / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Chronic total occlusion; Infarct related artery; Mortality; Rentrop grade; ST-elevation myocardial infarction