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Collateral Function Changes During Primary Percutaneous Coronary Intervention in Acute Myocardial Infarction: Effect on Infarct Size
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Andrea Remondino, Christian Seiler, Pascal Meier, Roby D. Rakhit, Kerstin Wustmann, Rainer Zbinden, Stephan Zbinden, Stephan Windecker, Mario Togni, Peter Wenaweser, Bernhard Meier and Franz R. Eberli
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Abstract
Background: This study in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction sought to test the hypotheses that collateral flow index (CFI) is reduced after unprotected recanalisation, or unaltered with protected PCI, and that collateral flow is related to
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Background: This study in patients undergoing primary percutaneous coronary intervention (PCI) for acute myocardial infarction sought to test the hypotheses that collateral flow index (CFI) is reduced after unprotected recanalisation, or unaltered with protected PCI, and that collateral flow is related to infarct size.
Methods and results: 46 patients (age 63 ± 12 years, 36 men, 10 women) with acute myocardial infarction underwent primary PCI of the occluded culprit vessel. Coronary collateral degree was assessed angiographically (score 0–3) before recanalisation of the occlusion. A sensor guide wire (Doppler or pressure sensor) was used for PCI to obtain CFI during the first two balloon occlusions. The study population was divided into two groups depending on the use of a coronary distal embolisation protection device (without protection device: n = 29, with protection device: n = 17). Infarct size was determined using serial serum creatine phosphokinase (CK) measurements up to 24 hours after PCI. There was an inverse relation between angiographic coronary collateral degree as obtained before PCI and peak CK level. In the group without but not with protection device, however, there was a trend to a direct relation between CFI and peak CK level. The CFI change between the 1st and 2nd balloon occlusions was –0.032 in the group without a protection device (p = 0.049), and +0.002 in the group with a protection device (p = 0.73).
Conclusion: In patients with acute myocardial infarction, collateral function becomes impaired following primary PCI in the absence but not in the presence of a distal coronary embolisation protection device. Coronary collateral degree obtained prior to PCI, but not collateral function determined during PCI, is inversely predictive of infarct size. Our study indicates that the latter is probably related to the fact that pressure- derived CFI in acute myocardial infarction reflects elevated left ventricular filling pressure rather than collateral function.
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