The Presence of Angiographic Collaterals in Non-ST Elevation Myocardial Infarction is a Predictor of Long-Term Clinical Outcomes
| Autor: | Kloepfer, Angela M., Lipson, Lewis C., Keeley, Ellen C. |
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| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Male
Chi-Square Distribution Time Factors Myocardial Infarction Collateral Circulation Kaplan-Meier Estimate Middle Aged Coronary Angiography Coronary Vessels Article Percutaneous Coronary Intervention Treatment Outcome Predictive Value of Tests Recurrence Risk Factors Coronary Circulation Multivariate Analysis Humans Female Prospective Studies Registries Coronary Artery Bypass Aged |
| Popis: | To determine whether the presence of angiographic coronary collaterals is a predictor of long-term clinical outcomes in patients with non-ST elevation myocardial infarction (NSTEMI).The presence of coronary collaterals on angiography provides prognostic information in patients with STEMI, but it is unknown whether they provide prognostic information in patients with NSTEMI.This was a prospective cohort study of 931 consecutive patients undergoing coronary angiography of which 269 (29%) had a NSTEMI. Baseline characteristics, angiographic details, and long-term clinical outcomes including death, recurrent MI, coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), stroke, and congestive heart failure (CHF) were collected. Each clinical outcome as well as the combined endpoint of death, recurrent MI, CABG, PCI stroke and CHF was compared in subjects with and without collaterals.At one year, individuals with collaterals had significantly increased rates of the combined endpoint compared with those without (25% vs. 16%, P = 0.0001). On multivariate analysis, the presence of collaterals was a strong predictor of the combined endpoint of death, recurrent MI, CABG, PCI, stroke and CHF (HR 1.95, CI 95% 1.08-3.52; P = 0.027). Similarly, in the subset of 115 patients (43%) in whom the culprit artery was identified, the presence of collaterals was a strong negative predictor (HR 3.71, CI 1.31-10.57, P = 0.014), driven by a 13-fold increase in subsequent CABG.In patients with NSTEMI the presence of angiographic coronary collaterals is a predictor of long-term clinical outcomes primarily driven by increased rates of surgical revascularization. |
| Databáze: | OpenAIRE |
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