Association of wide pulse pressure with coronary collateral flow in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention.

Abstract

Coronary collateral flow (CCF) is crucial for myocardial viability in patients with obstructive coronary artery disease, specifically ST-elevation myocardial infarction (STEMI). However, hypertension can contribute to vascular dysfunction and hinder the formation of CCF. Wide pulse pressure (WPP), defined as ≥65 mmHg, may better reflect impaired cardiovascular health compared to classic blood pressure indices. The effect of WPP on CCF remains unclear. Therefore, we aimed to evaluate the impact of WPP on CCF. This retrospective study included 1180 STEMI patients that underwent primary percutaneous coronary intervention (PCI) between 2021 and 2023 at a tertiary healthcare center. Patients were classified into good and poor CCF groups based on the Rentrop classification. Out of these patients, 272 (23.1%) had good CCF, while 908 (76.9%) had poor CCF. Two distinct models were constructed using multivariable logistic regression analysis to identify independent predictors of good CCF, including pulse pressure (Model 1) and WPP (Model 2). Covariates such as age, gender, diabetes mellitus, smoking, pre-infarction angina, Killip Class 3/4, multivessel disease, peak troponin, pre-thrombolysis in myocardial infarction (TIMI) flow 0, and previous PCI were added to both models. WPP was identified as an independent predictor that negatively influences good CCF (OR: 0.511, 95% CI: 0.334-0.783, p = 0.002). Moreover, diabetes, pre-infarction angina, Killip class III/IV, multivessel disease, and pre-TIMI flow 0 were also found to be independent predictors of CCF. WPP, derived from blood pressure measurements, has been associated with poor CCF in STEMI patients undergoing primary PCI and may serve as a predictor of poor CCF.