Author + information
- Received September 30, 2016
- Revision received December 24, 2016
- Accepted January 27, 2017
- Published online May 1, 2017.
- Joëlle Elias, MD,
- Loes P.C. Hoebers, MD, PhD,
- Ivo M. van Dongen, MD,
- Bimmer E.P.M. Claessen, MD, PhD and
- José P.S. Henriques, MD, PhD∗ ()
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. José P.S. Henriques, Academic Medical Center – University of Amsterdam, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Objectives This study sought to compare long-term clinical outcome in ST-segment elevation myocardial infarction (STEMI) patients with a concomitant chronic total occlusion (CTO) with well-developed versus poorly developed collaterals toward the CTO.
Background In STEMI patients, presence of a CTO is associated with increased morbidity and mortality. CTOs are often (partially) perfused by collateral vessels. Therefore, when the infarct-related artery (IRA) is the main donor vessel for the collateral blood supply of the CTO, infarct size may increase significantly. Well-developed collaterals to the infarct related vessel have been associated with improved clinical outcome after STEMI. However, the impact of well-developed collaterals toward a concomitant CTO in STEMI patients is unknown.
Methods Consecutive STEMI patients with a CTO in a non-IRA presenting for primary percutaneous coronary intervention (PCI) were divided according to the presence of angiographic, well-developed (grade 2 to 3) or poorly developed collaterals (grade 0 to 1).
Results Between 2000 and 2012 we included 413 STEMI patients with a single concomitant CTO. Well-developed collaterals to the CTO were present in 53%. Associated with poorly developed collaterals to the CTO were cardiogenic shock (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.11 to 3.07; p = 0.02), CTO located in the left circumflex artery (HR: 1.9; 95% CI: 1.00 to 3.43; p = 0.05), CTO diameter ≤2.5 mm (HR: 2.1; 95% CI: 1.07 to 4.12; p = 0.03), and CTO tapering (HR: 1.9; 95% CI: 1.21 to 2.85; p < 0.001). Patients with well-developed collaterals to the CTO had a better 5-year survival compared to those with poorly developed collaterals (74% vs. 63%; p = 0.01). The presence of well-developed collaterals to the CTO was independently associated with improved survival (HR: 1.5; 95% CI: 1.03 to 2.10; p = 0.04).
Conclusions In STEMI patients with a CTO in a non-IRA, the presence of well-developed collaterals to the CTO is associated with improved survival.
Dr. Henriques has received research grants from Abbott Vascular and Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 30, 2016.
- Revision received December 24, 2016.
- Accepted January 27, 2017.
- 2017 American College of Cardiology Foundation