{"doi":"10.1016/j.jacadv.2025.102169","title":"Cardioprotective Role of Coronary Collaterals in the Development of Intramyocardial Hemorrhage in ST-Segment Elevation MI Patients","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.","journal":"JACC Advances","year":2025,"id":524530,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9638,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":262183,"name":"Ankur Kalra","orcid":"0000-0003-0080-1660","position":1,"is_corresponding":false},{"id":1172799,"name":"Khalid Youssef","orcid":"0000-0003-4429-367X","position":2,"is_corresponding":false},{"id":1398584,"name":"Kinjal Bhatt","orcid":null,"position":3,"is_corresponding":false},{"id":1398038,"name":"Tejas Pandya","orcid":"0000-0002-1032-037X","position":4,"is_corresponding":false},{"id":763296,"name":"Andreas Kumar","orcid":"0000-0002-6994-4259","position":5,"is_corresponding":false},{"id":422490,"name":"Rohan Dharmakumar","orcid":"0000-0003-4120-4635","position":6,"is_corresponding":false},{"id":867619,"name":"Keyur Vora","orcid":"0000-0001-8833-9479","position":0,"is_corresponding":true}],"reference_count":38,"raw_metadata":null,"created_at":"2026-07-19T02:50:12.083054Z","pmid":"41005060","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}