Coronary collaterals provide cardioprotection in hemorrhagic ST-elevation MI
Bibliographic record
Abstract
Background: Intramyocardial hemorrhage (IMH), evident in 30-50% of revascularized STEMI patients, contributes to adverse outcomes in patients with acute ST-elevation myocardial infarction (STEMI).The development of IMH following reperfusion therapy is linked to increased infarct size, reduced myocardial salvage, adverse left ventricular (LV) remodeling, decreased left ventricular ejection fraction (LVEF), and a higher incidence of major adverse cardiovascular events post-myocardial infarction (MI).Despite the significant impact IMH imposes on patient outcomes, whether coronary collateral circulation modulates the development and extent of IMH following reperfusion has not been investigated. Methods:The MIRON-CL (NCT05898425) trial prospectively enrolled 294 STEMI patients who underwent reperfusion via primary percutaneous coronary intervention (PCI).From pre-PCI coronary angiography we assessed the presence and extent of coronary collaterals using the Rentrop grading system, ranging from Grade 0 (no collaterals) to Grade III (complete collateral filling).CMR was performed three days post-PCI.T2 mapping acquired for quantifying the extent of myocardial edema in the infarct territory (Area Affected), T2* mapping for determination of IMH, and LGE to assess Infarct Size as a percentage of LV mass (gm).Statistical methods were used to assess the relationships between collateral grades, Infarct Size, IMH, and the Area Affected.Results: Among the 294 STEMI patients, 124 were identified to be hemorrhagic, while 170 were non-hemorrhagic.Patients without coronary collaterals (Grade 0; CL-) exhibited significantly higher IMH volumes (7.41 ± 5.33% LV) compared to those with coronary collaterals (Grade I: 5.23 ± 3.21% LV, Grade II: 3.11 ± 2.78% LV, Grade III: 2.05 ± 1.89% LV; p< 0.001).The total Area Affected post-PCI was larger in patients without collaterals (37.62 ± 15.32% LV) compared to those with collaterals (21.48 ± 13.21% LV, p< 0.001).Additionally, the presence of collateral circulation was associated with smaller Infarct Size (CL-: 38.66 ± 14.63% LV vs. CL+: 19.84 ± 13.72% LV, p< 0.001) and reduced microvascular obstruction (MVO) volumes (CL-: 8.07 ± 6.60% LV vs. CL+: 2.17 ± 2.35% LV, p< 0.001).The absence of collaterals was also associated with a significantly higher multivariate adjusted risk for IMH (OR: 5.71, 95% CI: 3.16-10.33,p< 0.0001).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".