Abstract
Objective: Chronic total occlusion (CTO) is frequently found in coronary heart disease (CHD) with multivessel lesions. Patients with CTO are associated with an increased mortality rate. Management CTO requires specialized techniques, more resource utilization, and high cost. The progression of atherosclerosis can be prevented by controlling for risk factors. Monocyte to high-density lipoprotein ratio (MHR) is one of the new biomarkers used to assess the incidence of a major adverse cardiovascular event, the severity of coronary lesions, and the incidence of in-stent restenosis. This study was aimed to determine the role of MHR levels as a risk factor for the occurrence of CTO in CAD patients.
 Methods: This research is a matched case–control located in Sanglah General Hospital from August 2017 until October 2017. This research consisted of 47 cases with CTO and 47 control without CTO. Case and control samples were adjusted by sex, age, and number of blood vessels involved in CAD.
 Results: The cutoff value of MHR was also determined by analyzing the receiver operating curve. The optimal cut off point was 14.33 with sensitivity 83% and specificity 80.9%. Bivariate analysis showed high MHR was found strongly associated with the risk of CTO in CHD patients with odds ratio (OR)=61; IK 95% (OR)=3.211–114.15; p≤0.001. Multivariate analysis showed that high levels of MHR were significantly associated with risk of CTO after other traditional risk factors such as hypertension, diabetes mellitus, dyslipidemia, and smoking were controlled with OR=20,306; 95% IK (OR)=6.05–68.05; p≤0.001.
 Conclusion: High levels of MHR were significantly associated with the risk factor of CTO in CAD patients.
Highlights
Patients with coronary heart disease (CHD) have high morbidity and mortality rates
Bivariate analysis showed high Monocyte to high-density lipoprotein ratio (MHR) was found strongly associated with the risk of chronic total occlusion (CTO) in CHD patients with odds ratio (OR)=61; IK 95% (OR)=3.211–114.15; p≤0.001
Multivariate analysis showed that high levels of MHR were significantly associated with risk of CTO after other traditional risk factors such as hypertension, diabetes mellitus, dyslipidemia, and smoking were controlled with OR=20,306; 95% IK (OR)=6.05–68.05; p≤0.001
Summary
Patients with coronary heart disease (CHD) have high morbidity and mortality rates. In 2010, CHD was the cause of 80,000 deaths in the UK [2]. In 2016, there were 35% of CHD cases from all cardiovascular cases handled at Pelayanan Jantung Terpadu (PJT) Sanglah Hospital Denpasar [3]. Atherosclerotic plaques that continue to develop can rupture and cause thrombus blockage in coronary arteries. This can cause unstable angina, acute coronary syndrome, to sudden cardiac death. CTO events are often found in CHD with complex lesions and have a prevalence rate of 12–20% [5]. The prevalence of CTO in CHD patients treated at PJT Sanglah Hospital Denpasar is 15% [3]
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