Impacto de la circulación colateral en el pronóstico a largo plazo de los pacientes tratados con angioplastia primaria / Impact of coronary collaterals on long-term prognosis in patients treated with primary angioplasty

Introducción y objetivos: El efecto beneficioso de la circulación colateral (CC) coronaria en pacientes con infarto agudo de miocardio con elevación del segmento ST es controvertido. Se investigó su impacto antes de la reperfusión con angioplastia primaria (AP) en el pronóstico a largo plazo de estos pacientes. Métodos: Estudio observacional retrospectivo de una cohorte de 947 pacientes tratados con AP y flujo de grado TIMI ≤ 1 en un centro entre 2005 y 2013. Tras emparejar por puntuación de propensión, se obtuvieron 2 grupos de 175 pacientes emparejados por el grado de CC (Rentrop 0-1 frente a 2-3). En la cohorte emparejada se determinó el impacto de la CC en la mortalidad total, la mortalidad cardiovascular y un combinado de eventos cardiovasculares tras una mediana de seguimiento de 864 [intervalo intercuartílico, 396-1.271] días. Resultados: Del total de 947 pacientes incluidos, 735 (78%) tenían Rentrop 0-1 y 212 (22%), Rentrop 2-3. Durante el seguimiento, 105 fallecieron, 71 de causa cardiovascular. En la cohorte emparejada, la tasa de mortalidad total fue similar entre los grupos (Rentrop 0-1 [8,8%] frente a Rentrop 2-3 [6,3%]; HR = 1,22; IC95%, 0,50-2,94; p = 0,654). Tampoco hubo diferencias en la mortalidad cardiovascular (Rentrop 0-1, [4,6%] frente a Rentrop 2-3 [2,3%]; sub-HR = 0,49; IC95%, 0,14-1,62; p = 0,244) ni en el combinado de eventos muerte cardiovascular, reinfarto, revascularización del vaso diana y cirugía de revascularización coronaria (Rentrop 0-1 [18,8%] frente a Rentrop 2-3 [13,1%]; sub-HR = 0,68; IC95%, 0,40-1,15; p = 0,157). Conclusiones: En esta serie contemporánea, la presencia de buena CC antes de la AP no se asoció a mejor pronóstico de los pacientes en cuanto a eventos clínicos a largo plaz (AU)

Introduction and objectives: The beneficial effect of coronary collateral circulation (CC) in patients with ST-segment elevation myocardial infarction is controversial. The aim of this study was to evaluate the impact of CC before reperfusion with primary angioplasty (PA) on the long-term prognosis of these patients. Methods: Retrospective observational study of a cohort of 947 patients treated with PA and TIMI grade ≤ 1 flow in a single center from 2005 to 2013. Propensity score matching was used to create 2 groups of 175 patients each, matched by the degree of CC (Rentrop 0-1 vs Rentrop 2-3). In the matched cohort, we determined the impact of CC on total mortality, cardiovascular mortality, and a combined adverse cardiovascular event endpoint for a median follow-up of 864 (interquartile range, 396-1271) days. Results: Of a total of 947 patients included, 735 (78%) had Rentrop 0 to 1 and 212 (22%) had Rentrop 2 to 3. During follow-up, 105 patients died, 71 from cardiovascular causes. In the matched cohort, the total mortality rate was similar between the 2 groups (Rentrop 0-1 [8.8%] vs Rentrop 2-3 [6.3%]; HR = 1.22; 95%CI, 0.50-2.94; P = .654). There were no differences in cardiovascular mortality (Rentrop 0-1 [4.6%] vs Rentrop 2-3 [2.3%]; sHR = 0.49; 95%CI, 0.14-1.62; P = .244) or the composite endpoint including cardiovascular death, reinfarction, target vessel revascularization, and coronary artery bypass surgery (Rentrop 0-1 [18.8%] vs Rentrop 2-3 [13.1%]; sHR = 0.68; 95%CI, 0.40-1.15; P = .157). Conclusions: In this contemporary series, the presence of good CC before PA was not associated with better long-term clinical outcomes (AU)

Impact of Coronary Collaterals on Long-term Prognosis in Patients Treated With Primary Angioplasty.

INTRODUCTION AND OBJECTIVES: The beneficial effect of coronary collateral circulation (CC) in patients with ST-segment elevation myocardial infarction is controversial. The aim of this study was to evaluate the impact of CC before reperfusion with primary angioplasty (PA) on the long-term prognosis of these patients. METHODS: Retrospective observational study of a cohort of 947 patients treated with PA and TIMI grade ≤ 1 flow in a single center from 2005 to 2013. Propensity score matching was used to create 2 groups of 175 patients each, matched by the degree of CC (Rentrop 0-1 vs Rentrop 2-3). In the matched cohort, we determined the impact of CC on total mortality, cardiovascular mortality, and a combined adverse cardiovascular event endpoint for a median follow-up of 864 (interquartile range, 396-1271) days. RESULTS: Of a total of 947 patients included, 735 (78%) had Rentrop 0 to 1 and 212 (22%) had Rentrop 2 to 3. During follow-up, 105 patients died, 71 from cardiovascular causes. In the matched cohort, the total mortality rate was similar between the 2 groups (Rentrop 0-1 [8.8%] vs Rentrop 2-3 [6.3%]; HR = 1.22; 95%CI, 0.50-2.94; P = .654). There were no differences in cardiovascular mortality (Rentrop 0-1 [4.6%] vs Rentrop 2-3 [2.3%]; sHR = 0.49; 95%CI, 0.14-1.62; P = .244) or the composite endpoint including cardiovascular death, reinfarction, target vessel revascularization, and coronary artery bypass surgery (Rentrop 0-1 [18.8%] vs Rentrop 2-3 [13.1%]; sHR = 0.68; 95%CI, 0.40-1.15; P = .157). CONCLUSIONS: In this contemporary series, the presence of good CC before PA was not associated with better long-term clinical outcomes.