Abstract
Background: Obesity is an independent risk factor for cardiovascular disease. We investigated whether and to what extent visceral obesity-related indices were associated with coronary collateralization (CC) in chronic total occlusion (CTO) patients.Methods: This retrospective cohort study involved 1,008 consecutive patients with CTO who underwent CTO-percutaneous coronary artery intervention (PCI). CC was graded according to the Rentrop scoring system. Data on demographic and clinical characteristics were collected by cardiovascular doctors. Logistic regression, receiver operating characteristic (ROC) curve and Kaplan-Meier analyses were performed to assess the predictive value of visceral obesity-related indices for CC.Results: Overall, 1,008 inpatients were assigned to the poor CC group (n = 592) and good CC group (n = 416). In multivariate-adjusted logistic regression analyses, all visceral obesity-related indices (P-value < 0.001) were significantly associated with CC. After ROC analysis and the Delong test, the Chinese visceral adiposity index (CVAI) had the largest area under the curve (AUC) of 0.741 (0.711–0.771). Further analysis revealed that CVAI quartile remained a risk factor for poor CC in all groups, CVAI was associated with a 1.018-fold higher risk of poor CC (OR = 1.018, 95% CI: 1.014–1.021, P < 0.001). Individuals in the top CVAI quartile group had the highest risk of poor CC (OR = 10.657, 95% CI: 6.492–17.493, P < 0.001). Subgroup analyses showed similar results, and CVAI quartile remained a risk factor for poor CC. Moreover, increased CVAI predicted poor prognosis in CTO patients.Conclusion: In summary, this study indicated that all the increased visceral obesity-related indices were significantly associated with increased poor CC risk. After adjusting for potential risks, CVAI had the best performance for estimating CC and predicting prognosis in CTO patients.
Highlights
Chronic coronary total occlusions (CTOs) are defined as 100% occlusions with Thrombolysis in Myocardial Infarction (TIMI) 0 flow and at least a 3-month duration [1]
Compared to patients with good Coronary collateralization (CC), the prevalence of T2DM, age and sex were significantly different among the CTO patients with poor CC
After adjustment for several potential risk factors, such as age, sex, CTO duration, resting heart rate (RHR), current smoking status, history of T2DM, fasting blood glucose (FBG), TGs, left ventricular ejection fraction (LVEF), quartiles of body mass index (BMI), Waist-hip ratio (WHR), waist-to-height ratio (WHtR), cardiometabolic index (CMI), lipid accumulation product (LAP), body adiposity index (BAI), and Chinese visceral adiposity index (CVAI) remained independent predictors of poor CC
Summary
Chronic coronary total occlusions (CTOs) are defined as 100% occlusions with Thrombolysis in Myocardial Infarction (TIMI) 0 flow and at least a 3-month duration [1]. Previous studies have demonstrated the correlation between body mass index (BMI), the most widely used clinical indicator for evaluating obesity, and CC and have shown that compared to patients with a normal BMI, obese patients (defined as BMI ≥ 30 kg/m2) have poor CC and a significantly higher risk of major adverse cardiovascular events [10]. An increasing number of studies have reported that visceral obesity, compared to overall obesity, might be a better determinant of cardiovascular disease (CVD) risk [14, 15]. To the best of our knowledge, there has been no study evaluating the correlations of various visceral obesity-related indices with CC of patients with CTO. We investigated whether and to what extent visceral obesity-related indices were associated with coronary collateralization (CC) in chronic total occlusion (CTO) patients
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