Coronary collateral circulation status is correlated with the initial electrocardiographic pattern in ST-elevation myocardial infarction

Introduction

The status of coronary collateral circulation (CC) in the first hours of ST-elevation myocardial infarction (STEMI) may influence outcome. Early recognition of the CC status may have therapeutic and prognostic implications. Our purpose was to correlate the electrocardiogram (ECG) pattern and CC in STEMI.

Methods

We analyzed ECG and angiographic CC in 242 consecutive patients (62 ± 14 years, 79% male) with STEMI treated with primary angioplasty. Patients were divided into two groups based on the magnitude of ST elevation with/without distortion of the terminal portion of the QRS (group 1/group 2). The degree of collateral filling (Rentrop) was assessed as grade 0 = none, grade 1 = filling of side branches of the occluded artery, grade 2 = partial epicardial filling, and grade 3 = complete epicardial filling of the occluded artery.

Results

ST elevation with distortion of the terminal portion of QRS were present at initial ECG in 55 patients (23%). This group had a lower incidence of Rentrop grade 2/3 than group 2 (P = 0.006, Figure 1). Moreover, group 1 had higher enzyme release, worse maximal Killip class and more frequently the combined variable death/shock. Group 1 more often had proximal occlusion of the infarction-related artery and nonreflow. Multivariate analysis found ECG to be an independent predictor of outcome.

Figure 1

Conclusion

ST elevation with distortion of the terminal portion of QRS predicts impaired CC. Early recognition of this pattern should warrant prompt treatment.