The role of antegrade and collateral flow in relation to left ventricular function post-thrombolysis

The aim of the study was to analyze the relationship between antegrade and collateral flow degree to the “culprit” coronary artery, and between both variables and left ventricular systolic function. We analyzed five hundred patients with acute myocardial infarction, treated prospectively and consecutively within 6 h of evolution with intravenous streptokinase. The degree of antegrade (0–3) and collateral blood flow (0–3) were correlated with 18 other variables. Results: (a) By simple regression analysis, antegrade flow degree correlated positively (p<0.0001), and collateral flow degree negatively (p=0.0073) with left ventricular ejection fraction; (b) By multiple regression analysis, antegrade flow degree (p=0.0032), but not collateral flow degree (p>0.1), correlated independently with left ventricular ejection fraction; (c) In the subgroup of patients with occluded “culprit” coronary artery, the mean ejection fraction was significantly higher for those with collateral flow 3 (60.2%±13.3) in relation to those with collateral flow <3 (53.9%±13.1, p=0.032, 95% CI 11.96 to 0.53%). In conclusion, antegrade coronary flow degree, but not collateral flow degree, correlated significantly and independently with left ventricular ejection fraction. However, in the subgroup of patients with occluded “culprit” coronary artery, collateral flow 3 led to better left ventricular systolic function, in relation to collateral flow <3.