Correlation of left ventricular contractile function with the presence of collateral coronary circulation in non-reperfused acute myocardial infarction

Diego R. Campos-Franco, Unidad de Cuidados Coronarios, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
Hector González-Pacheco, Coronary Care Unit, Instituto Nacional de Cardiología “Ignacio Chávez”, Mexico City, Mexico
Alexandra Arias-Mendoza, Cardióloga Especialista en Medicina Crítica, Centro Médico ABC Observatorio, Ciudad de México, México; Jefa de Urgencias y Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México

Objective: To assess the association between coronary collateral circulation and ventricular contractile function in patients with non-reperfused acute myocardial infarction. Method: A retrospective and descriptive clinical study was conducted on patients with ST-elevation myocardial infarction (STEMI) at a reference cardiovascular center, from January 2006 to December 2022. Coronary angiographies and echocardiograms were reviewed to evaluate coronary collateral circulation and ventricular function, respectively. Patients were divided into groups based on the presence of collateral circulation. Both groups were compared and mortality during the index hospitalization was analyzed. Results: Out of a total of 14,985 patients with acute coronary syndrome, 8134 (54.3%) had the diagnosis of STEMI. We excluded 12,880, leaving a total of 2105 non-reperfused STEMI patients who underwent coronary angiography, revealing lesions. There were more patients without collateral circulation: 1547 (73.5%) vs. 558 (26.5%) (p = 0.025). Patients without collateral circulation had a higher left ventricular ejection fraction (median of 47% vs. 42%; p < 0.001). Mortality in patients with collateral circulation was higher compared to those without it (11.6% vs. 9.8%; p = 0.225), but statistical significance was not reached. Conclusions: Non-reperfused STEMI patients did not show protection from collateral circulation when assessing left ventricular systolic function. We did not find a difference in mortality compared to the population without development of collateral circulation.

Keywords: Acute myocardial infarction. Coronary collateral circulation. Ventricular function. Cardiovascular disease. Major adverse cardiovascular events.