Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course
Background: Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI). Methods:...
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Elsevier
2024-09-01
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| Series: | Indian Heart Journal |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0019483224001895 |
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| author | Rajesh Kumar Naveed Ullah Khan Ayaz Mir Khalid Naseeb Gulzar Ali Arti Ashok Mukesh Kumar Abiha Urooj Uroosa Safdar Aisha Hussain Muhammad Ishaq Tahir Saghir Jawaid Akbar Sial Abdul Hakeem Musa Karim |
| author_facet | Rajesh Kumar Naveed Ullah Khan Ayaz Mir Khalid Naseeb Gulzar Ali Arti Ashok Mukesh Kumar Abiha Urooj Uroosa Safdar Aisha Hussain Muhammad Ishaq Tahir Saghir Jawaid Akbar Sial Abdul Hakeem Musa Karim |
| author_sort | Rajesh Kumar |
| collection | DOAJ |
| description | Background: Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI). Methods: The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2–3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course. Results: In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97–0.99], 1.69 [1.35–2.10], and 3.45 [2.64–4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively. Conclusion: Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC. |
| format | Article |
| id | doaj-art-2d3a50dc794947329bb6b97d9acf6d77 |
| institution | OA Journals |
| issn | 0019-4832 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Elsevier |
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| series | Indian Heart Journal |
| spelling | doaj-art-2d3a50dc794947329bb6b97d9acf6d772025-08-20T02:13:58ZengElsevierIndian Heart Journal0019-48322024-09-0176535836310.1016/j.ihj.2024.10.006Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital courseRajesh Kumar0Naveed Ullah Khan1Ayaz Mir2Khalid Naseeb3Gulzar Ali4Arti Ashok5Mukesh Kumar6Abiha Urooj7Uroosa Safdar8Aisha Hussain9Muhammad Ishaq10Tahir Saghir11Jawaid Akbar Sial12Abdul Hakeem13Musa Karim14Corresponding author. National Institute of Cardiovascular Diseases (NICVD), Pakistan.; National Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanNational Institute of Cardiovascular Diseases (NICVD), Karachi, PakistanBackground: Limited data exist on the role of coronary collaterals circulation (CCC) in patients with ST-elevation acute coronary syndrome (STE-ACS). This study aimed to assess CCC and the in-hospital course of patients with CCC undergoing primary percutaneous coronary intervention (pPCI). Methods: The study included consecutive STE-ACS patients undergoing pPCI. Good CCC was defined as Rentrop collateral score (RCS) of 2–3. Patients with good and poor CCC were compared regarding clinical characteristics, angiographic patterns, and hospital course. Results: In the sample of 4683 patients, mean age was 55.6 ± 11 years, and 78.8 % were male. Good CCC was observed in 499 (10.7 %) patients. The rate of intra-procedure slow-flow/no-reflow (SF/NR) was 29.9 % vs. 20.5 % (p < 0.001), and the rate of composite adverse clinical outcomes (CACO) was 21.2 % vs. 19 % (p = 0.225) for patients with good and poor CCC, respectively. Multivariable analysis identified left ventricular end-diastolic pressure (LVEDP), multi-vessel disease (MVD), and thrombus grade ≥4 as independent predictors of good CCC, with adjusted odds ratios of 0.98 [0.97–0.99], 1.69 [1.35–2.10], and 3.45 [2.64–4.52], respectively. In propensity-matched cohorts, the intra-procedure SF/NR rate was 29.9 % vs. 26.9 % (p = 0.292), and the rate of CACO was 21.2 % vs. 23.4 % (p = 0.403) for patients with good and poor CCC, respectively. Conclusion: Angiographic evidence of good CCC in STE-ACS patients was limited. Good CCC was associated with a higher prevalence of MVD, high thrombus burden, and low pre-procedure LVEDP, resulting in a higher incidence of intra-procedure SF/NR. However, the CACO did not differ significantly between patients with good and poor CCC.http://www.sciencedirect.com/science/article/pii/S0019483224001895ST-elevation acute coronary syndromeCoronary collaterals flowPrimary percutaneous coronary interventionAdverse clinical outcomes |
| spellingShingle | Rajesh Kumar Naveed Ullah Khan Ayaz Mir Khalid Naseeb Gulzar Ali Arti Ashok Mukesh Kumar Abiha Urooj Uroosa Safdar Aisha Hussain Muhammad Ishaq Tahir Saghir Jawaid Akbar Sial Abdul Hakeem Musa Karim Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course Indian Heart Journal ST-elevation acute coronary syndrome Coronary collaterals flow Primary percutaneous coronary intervention Adverse clinical outcomes |
| title | Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course |
| title_full | Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course |
| title_fullStr | Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course |
| title_full_unstemmed | Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course |
| title_short | Do collaterals to infarct bed in STE-ACS patients undergoing emergent percutaneous coronary revascularization matter? An assessment of a prospective pool for in-hospital course |
| title_sort | do collaterals to infarct bed in ste acs patients undergoing emergent percutaneous coronary revascularization matter an assessment of a prospective pool for in hospital course |
| topic | ST-elevation acute coronary syndrome Coronary collaterals flow Primary percutaneous coronary intervention Adverse clinical outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S0019483224001895 |
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