Kardiologia polska 2017 05 29() doi 10.5603/KP.a2017.0078
Due to ischemic time delays from the chest pain occurrence in acute STEMI, prompt recruitment collaterals (PRCCs) to infarct related artery (IRA) are the major protective structures during this period. So, we aimed to investigate the clinical significance and determinants of PRCCs in acute STEMI patients.
A total of 1375 consecutive acute STEMI patients were prospectively enrolled in the study. The patients were divided in two groups, according to PRCCs to IRA; Rentrop≤1 were defined as inadequate collateral development (ICD) group and Rentrop≥2 defined as adequate collateral development (ACD) group.
Patients in ICD group had higher incidence of baseline risk characteristics including older age, hypertension and DM; however, pre-infarct angina incidence was lower than ACD group (p<0.05 for all). In addition, the ICD group had worse hemodynamic status on admission and 30-day mortality. Compared to ACD group, the non-IRA CTO, peak troponin-T, NT-proBNP, and hs-CRP levels were higher in ICD group. On multivariate logistic regression analysis, non-IRA CTO (β=3.114, 95% CI=1.382-7.017, p<0.006) with pre-infarction angina together with higher values of peak troponin-T, NT-proBNP, and hs-CRP were associated with PRCCs in acute STEMI. CONCLUSION
Taken that into account the main message of the study is that if patient has higher cardiac biomarkers and adverse clinical findings (which, of note, may show the extent of MI) and have non-IRA CTO, there is higher chance that they will have inadequate collateralization.