Abstract 2394: Significant Coronary Collaterals to the Infarct Related Artery Prevent Early Death But Predict Late Death in Patients With Acute Myocardial Infarction
Background: Significant collateral flow (SCF) to the infarct-related artery (IRA) is believed to have beneficial effects in patients with acute myocardial infarction (AMI). However, it is still controversial whether SCF is associated with the improved long term mortality after AMI in the primary percutaneous coronary intervention (PCI) era.
Methods: We investigated clinical outcomes in 2,114 consecutive patients with AMI (76% men, mean age 64 years) who were registered to the Osaka Acute Coronary Insufficiency Study between 1999 to 2005 and fulfilled the following criteria :
coronary angiography within 48 hours after the onset,
the complete occlusion of the IRA, and
evaluation of angiographic collateral flow with the Rentrop’s (R) collateral score ; R-0 = no collaterals, to R-3 = collaterals completely filling the IRA.
Results: The prevalence of diabetes mellitus, hypertension, hyperlipidemia, smoking, admission heart failure (Killip class II or more), and successful PCI were comparable among the patients with R-0, R-1, R-2, and R-3 collaterals. Patients with R-0, R-1, R-2, and R-3 collaterals had significant difference in admission blood glucose levels (184±88, 175±70, 176±81 and 169±72 mg/dl, respectively, p=0.046), peak CK levels (3,626±2,759, 3,352±2,460, 2,825±2,290 and 2,637±2,217 U/L, respectively, p<0.001) and 30-day mortality (5.9%, 1.4%, 1.5% and 1.6%, respectively, p<0.001), suggesting the salutary effects of R-3 collaterals in the acute stage of AMI. Interestingly, however, patients with R-3 collaterals had the worst 1-year mortality (7.6%, 2.5%, 3.2% and 8.8%, for patients with R-0,1,2,3 collaterals, respectively, p<0.001). Multivariate analysis revealed that presence of R-3 collaterals was significantly associated with higher age, longer time to admission, multi-vessel disease and previous myocardial infarction.
Conclusions: SCF to the IRA was associated with the improved early clinical outcomes, but related with the worst 1-year mortality in patients with AMI. SCF in the acute phase of AMI may be a reflection of the worse profiles of the patients and predict not early but late death. Patients with AMI and such SCF should be paradoxically treated as those at the highest risk after discharge in the real world.