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In the setting of reperfusion therapy for acute myocardial infarction, several studies have indicated the importance of coronary collaterals for subsequent improvement of cardiac function or reduction of infarct size.1-5 Habib and colleagues' have reported in this issue of Circulation a detailed post hoc analysis of coronary collaterals from the Thrombolysis in Myocardial Infarction (TIMI) Phase I trial. In this study of 125 patients from TIMI-I who had an occluded infarct vessel at baseline angiography and 90 minutes after intravenous thrombolytic therapy, the 51 patients (41%) with demonstrable collaterals had (compared with patients without collaterals) a 35% reduction in infarct size by creatine kinase methodology and a relative 12% improvement in ejection fraction (+2.7 versus -2.4 units) by paired contrast ventriculography. These findings confirm earlier observations with intracoronary thrombolytic therapy. Rogers and associates2 analyzed patients with failed reperfusion

Coronary collaterals revisited. Accessory pathway to myocardial preservation during infarction.