Objectives
Coronary collateral circulation (CCC) may restrict the size of right ventricular (RV) infarcts however the relation between CCC and clinical adverse events in patients with inferior STEMI was not demonstrated clearly. Thus, this study aimed to evaluate the relation between preintervention angiographic evidence of CCC and clinical outcomes among patients with acute inferior STEMI who were undergone percutaneous coronary intervention (PCI).
Methods
Totally, 235 inferior STEMI patients applied within first 12 hours from the symptom onset were consecutively included in this prospective study. The patients treated with PCI on the LCx or the LAD as the culprit vessels were excluded. Additionally, the patients with coronary artery stenosis of >70% at the LCx and/or the LAD were excluded. Presence of CCC to the RCA before PCI was evaluated angiographically and two groups were established as follows: 147 patients without CCC (63%) and 88 with CCC (37%). RV dysfunction was defined according to the rules set by American Society of Echocardiography. Echocardiographic evaluation of the RV function was completed by the assessment of right ventricular fractional area change, tricuspid annular plane systolic excursion and right ventricular free wall motion. The primary objective of this study was to examine in-hospital death. Secondary objectives were to examine the occurrence of RV infarction, complete AV block, cardiogenic shock and VT/VF.
Methods
Totally, 235 inferior STEMI patients applied within first 12 hours from the symptom onset were consecutively included in this prospective study. The patients treated with PCI on the LCx or the LAD as the culprit vessels were excluded. Additionally, the patients with coronary artery stenosis of >70% at the LCx and/or the LAD were excluded. Presence of CCC to the RCA before PCI was evaluated angiographically and two groups were established as follows: 147 patients without CCC (63%) and 88 with CCC (37%). RV dysfunction was defined according to the rules set by American Society of Echocardiography. Echocardiographic evaluation of the RV function was completed by the assessment of right ventricular fractional area change, tricuspid annular plane systolic excursion and right ventricular free wall motion. The primary objective of this study was to examine in-hospital death. Secondary objectives were to examine the occurrence of RV infarction, complete AV block, cardiogenic shock and VT/VF.
Results
Baseline clinical, echocardiographic characteristics, beginning clinical values and in-hospital therapy of the groups were listed in Table 1. There were no statistically significant differences between the groups in respect to presence of multivessel disease, TIMI flow before PCI in RCA and major RV branch artery. RV infarction, complete atrioventricular block, VT/VF, cardiogenic shock and in-hospital death were noted less frequently in patients with CCC than in those without CCC. Age, male sex, diabetes mellitus, left ventricular ejection fraction, door to balloon time, time from symptoms onset to PCI, absence of CCC to RCA, multivessel coronary artery disease, coronary lesion location and successful primary angioplasty were analyzed using multivariate logistic regression to estimate their predictive value for in-hospital death. Absence of CCC to RCA was found to be the independent predictor for in-hospital death among them (odds ratio 4.0, 95% confidence interval 1.8-12.6; p=0.03).
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