title: Which Coronary Lesions Are More Prone to Cause Acute Myocardial Infarction?
abstract: According to common belief, most myocardial infarctions (MIs) are due to the rupture of nonsevere, vulnerable plaques with < 70% obstruction. Data from recent trials challenge this belief, suggesting that the risk of coronary occlusion is, in fact, much higher after severe stenosis. The aim of this study was to investigate whether or not acute ST-elevation MIs result from high-grade stenoses by evaluating the presence of coronary collateral circulation (CCC).
  We retrospectively included 207 consecutive patients who had undergone primary percutaneous coronary intervention for acute ST-elevation MI. Collateral blood flow distal to the culprit lesion was assessed by two investigators using the Rentrop scoring system.
  Out of the 207 patients included in the study, 153 (73.9%) had coronary collateral vessels (Rentrop 1-3). The Rentrop scores were 0, 1, 2, and 3 in 54 (26.1%), 50 (24.2%), 51 (24.6%), and 52 (25.1%) patients, respectively. Triglycerides, mean platelet volume (MPV), white cell (WBC) count, and neutrophil count were significantly lower in the group with good collateral vessels (p = 0.013, p = 0.002, p = 0.003, and p = 0.021, respectively).
  More than 70% of the patients with acute MI had CCC with Rentrop scores of 1-3 during primary coronary angiography. This shows that most cases of acute MI in our study originated from underlying high-grade stenoses, challenging the common believe. Higher serum triglycerides levels, greater MPV, and increased WBC and neutrophil counts were independently associated with impaired development of collateral vessels.
  Há uma crença geral de que a maioria dos infartos agudos do miocárdio (IAM) ocorrem devido à ruptura de placas vulneráveis, não graves, com obstrução < 70%. Dados de ensaios recentes desafiam esta crença, sugerindo que o risco de oclusão coronariana é, na realidade, muito maior após estenose grave. O objetivo deste estudo foi investigar se a presença ou não de IAM com supradesnível do segmento ST resulta de estenoses de alto grau através da avaliação da presença de circulação colateral coronariana (CCC).
  Nós incluímos retrospectivamente 207 pacientes consecutivos submetidos à intervenção coronariana percutânea primária devido à ocorrência de IAM com supradesnível do segmento ST. O fluxo sanguíneo colateral distal à lesão culpada foi avaliado por dois investigadores com utilização do sistema de escores de Rentrop.
  Dos 207 pacientes incluídos no estudo, 153 (73,9%) apresentavam vasos coronarianos colaterais (Rentrop 1-3). Os escores Rentrop foram de 0, 1, 2 e 3 em 54 (26,1%), 50 (24,2%), 51 (24,6%) e 52 (25,1%) pacientes, respectivamente. Triglicérides, volume plaquetário médio (VPM), contagem de células brancas (CCB) e contagem de neutrófilos estiveram significativamente mais baixos no grupo com bons vasos colaterais (p = 0,013, p = 0,002, p = 0,003 e p = 0,021, respectivamente).
  Mais de 70% dos pacientes com IAM apresentaram CCC com escores de Rentrop de 1-3 durante angiografia coronariana primária. Isto demonstra que a maioria dos casos de IAM em nosso estudo originou a partir de estenoses subjacentes de alto grau, contrariamente à sabedoria comum. Níveis séricos mais elevados de triglicérides, maior VPM e elevação na CCB e na contagem de neutrófilos estiveram independentemente associados com comprometimento no desenvolvimento de vasos colaterais.
authors.affiliation: Dumlupinar University Kutahya Evliya Celebi Education and Research Hospital, Kutahya - Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Sen
authors.affiliation: Dumlupinar University Kutahya Evliya Celebi Education and Research Hospital, Kutahya - Turkey.
authors.forename: Mehmet Ali
authors.initials: MA
authors.lastname: Astarcioglu
authors.affiliation: Sivas Cumhuriyet University, Sivas - Turkey.
authors.forename: Osman
authors.initials: O
authors.lastname: Beton
authors.affiliation: Diskapi Education and Research Hospital, Ankara - Turkey.
authors.forename: Lale Dinc
authors.initials: LD
authors.lastname: Asarcikli
authors.affiliation: Dumlupinar University Kutahya Evliya Celebi Education and Research Hospital, Kutahya - Turkey.
authors.forename: Celal
authors.initials: C
authors.lastname: Kilit
mesh_terms: D000368:Aged; D003097:Collateral Circulation / Q000502:physiology*; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012016:Reference Values; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000209:etiology* / Q000503:physiopathology*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric