Cardioprotective Role of Coronary Collaterals in the Development of Intramyocardial Hemorrhage in ST-Segment Elevation MI Patients
Bibliographic record
Abstract
BACKGROUND: Intramyocardial hemorrhage (IMH), evident in 40% of revascularized ST-segment elevation myocardial infarction (STEMI) patients, is a lethal determinant of MI size. IMH compromises myocardial salvage and drives major adverse cardiovascular events. OBJECTIVES: We sought to determine whether the presence and extent of coronary collaterals affect development of IMH in STEMI patients. METHODS: The MIRON-CL trial (NCT05898425) enrolled 294 consecutive STEMI patients reperfused via primary percutaneous coronary intervention (PCI). All underwent pre-PCI angiography to determine Rentrop collateral grades (0: none; III: complete). Three days post-PCI cardiac magnetic resonance imaging quantified myocardial area at risk (T2 edema), IMH (T2∗), and MI (late gadolinium enhancement). RESULTS: Among 294 patients, 124 had IMH and 170 did not. Patients with no collaterals (CL-, Grade 0) had higher IMH (7.41% ± 5.33% left ventricle) than those with collaterals (CL+; Grade I: 5.23% ± 3.21%, II: 3.11% ± 2.78%, III: 2.05% ± 1.89%; P < 0.001). Total area at risk post-PCI was larger in CL- (37.62% ± 15.32% left ventricle) than in CL+ (21.48% ± 13.21%; P < 0.001). Absence of collaterals correlated with larger MI (CL- 38.66% ± 14.63% vs CL+ 19.84% ± 13.72%; P < 0.001) and higher microvascular obstruction (CL- 8.07% ± 6.60% vs CL+ 2.17% ± 2.35%; P < 0.001). Patients without collaterals had a higher adjusted risk of IMH (OR: 5.71; 95% CI: 3.16-10.33; P < 0.0001). CONCLUSIONS: Extent of coronary collaterals is a determinant of IMH in revascularized STEMI. Since IMH is known to drive post-PCI infarct expansion, determination of collateral status has the potential to identify patients at high risk of infarct expansion. For these high-risk patients, novel targeted therapies to reduce IMH, limit post-MI infarct expansion, and improve outcomes should be further explored.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".