Frequency of myocardial infarction and its relationship to angiographic collateral flow in territories supplied by chronically occluded coronary arteries

Jin Ho Choi, Sung A. Chang, Jin Oh Choi, Young Bin Song, Joo Yong Hahn, Seung Hyuk Choi, Sang Chol Lee, Sang Hoon Lee, Jae K. Oh, Yeon Hyeon Choe, Hyeon Cheol Gwon

Research output: Contribution to journalArticlepeer-review

81 Scopus citations

Abstract

Background-Despite complete interruption of antegrade coronary artery flow in the setting of a chronic total occlusion (CTO), clinical recognition of myocardial infarction is often challenging. Using cardiac MRI, we investigated the frequency and extent of myocardial infarction in patients with CTO, and assessed their relationship with regional systolic function and the extent of angiographic collateral flow. Methods and Results-We included 170 consecutive patients (median age, 62 years) with angiographically documented CTO. Regional late gadolinium enhancement and wall motion score index were assessed by cardiac MRI with the use of a 17-segment model. Angiographic collateral flow was assessed by the collateral connection grade and the Rentrop score. Evidence of previous myocardial infarction was found in 25% of patients by ECG Q waves, in 69% by regional wall motion abnormality, and in 86% of patients by late gadolinium enhancement. Increased angiographic collateral flow was associated with a lower frequency of Q waves on ECG, and a lower regional wall motion score index, late gadolinium enhancement volume (%), and degree of late gadolinium enhancement transmurality (all P<0.001), as well. Conclusions-The frequency of myocardial infarction in territories subtended by CTO is significantly higher than previously recognized. The degree of myocardial injury downstream epicardial CTO is inversely correlated with the degree of angiographic collaterals. (Circulation. 2013;127:703-709.).

Original languageEnglish (US)
Pages (from-to)703-709
Number of pages7
JournalCirculation
Volume127
Issue number6
DOIs
StatePublished - Feb 12 2013

Keywords

  • Cardiac MRI
  • Chronic total occlusion
  • Coronary collateral vessel

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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