Good Coronary Collateral Circulation Research Articles

Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion.

Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals. To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS. A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses. The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC. The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

Are Thiols Useful Biomarkers for Coronary Collateral Circulation in Patients with Stable Coronary Artery Disease?

Our aim was to investigate the relationship between thiol, which is the main component of the antioxidant system, and coronary collateral circulation (CCC). Our patients consisted of people with stable coronary artery disease (sCAD) and total occlusion in at least one vessel (n = 249). We divided the patients into two groups, good and poor, according to their CCC degree. We determined that DM, total thiol, and disulfide are independent predictors of poor CCC in multivariate logistic regression analysis (OR: 1.012, 95% CI: 1.008-1.017, p < 0.001; OR: 1.022, 95% CI: 1.000-1.044, p = 0.044; OR: 2.671, 95% CI: 1.238-5.761, p = 0.012, respectively). The ROC analysis showed a cut-off value of 328.7 for native thiol regarding the prediction of poor CCC, with 67.4% specificity and 78% sensitivity. For disulfide, it revealed a cut-off value of 15.1 regarding the prediction of poor CCC, with 57.9% specificity and 69.5% sensitivity. In this study, we detected that the patients with sCAD who developed poor CCC had lower levels of native thiol, total thiol, and disulfide compared to those with good CCC. The most interesting finding of our study is that CCC formation is an effective predictor of the antioxidant cascade rather than the inflammation cascade in sCAD patients.

Comparison of the effect of uric acid/albumin ratio on coronary colleteral circulation with other inflammation-based markers in stable coronary artery disease patients.

The Uric acid/Albumin ratio (UAR) has recently been identified as a prominent marker in cardiovascular diseases. In this study, we aimed to reveal the effect of UAR on coronary collateral circulation (CCC) in patients with stable coronary artery disease (CAD) patients by comparing it with conventional inflammation-based markers. In this study, 415 consecutive patients who underwent coronary angiography for stable angina pectoris and were found to have chronic total occlusion in at least one coronary artery were retrospectively included. The study population was divided into two groups as good CCC (Rentrop 2-3) and poor CCC (Rentrop 0-1) according to the Rentrop classification, and the groups were compared in terms of UAR and other traditional inflammation-based markers. In the poor CCC group, C-reactive protein/albumin ratio (CAR), monocyte/high-density lipoprotein cholesterol ratio (MHR), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and UAR were found to be significantly high (p < .05, for all). UAR negatively correlated with rentrop classification (r = -0.383, p < .001). In multivariate regression analysis, MHR, NLR, SII and UAR were determined as independent predictors for poor CCC (p < .05, for all). The ability of UAR to predict poor CCC was superior to uric acid and albumin alone (p < .0001, for both). In addition, UAR was found to be superior to other inflammation-based markers in predicting poor CCC (p < .005, for all). UAR was identified as a strong and independent predictor of CCC. In this context, UAR may be a useful biomarker in the risk prediction of patients with stable CAD.

Association of Visceral Fat Index with Coronary Collateral Circulation in Patients with Coronary Artery Disease

Abstract: Background: Coronary collateral circulation (CCC) is a network of anastomosing channels, established by heart in response to ischemia of myocardium. Hypertension, diabetes mellitus, and BMI are well established risk factors for development of poor CCC. Good CCC minimizes symptoms of angina, reduce the size of infarcts and prevent adverse cardiac events. The current research study was designed to find out the association of visceral adiposity and development of CCC among patients with coronary artery disease. Materials and Methods: The prospective study, conducted in Civil Hospital Karachi, comprised of 270 patients of coronary artery disease. According to the Rentrop Cohen categorization, patients were placed into two groups: the group with good collateral circulation having Rentrop grades i2-3 (n = 140) and the group with poor collateral circulation having Rentrop grades i0-1(n = 130). Rentrop score was determined by angiography. Segmental multi-frequency bioelectrical impedance analyzer was used to determine body fat mass and body muscle mass. Using Omron body fat and weight measurement systems, visceral fat index (VFI) was evaluated to determine the composition of visceral adipose tissue. SPSS was used for data analysis (Version 22). To assess the independent risk factor for poor CCC, logistic regression analysis was used. ROC curve was constructed to assess the efficacy of VFI in identifying CCC. Results: Overall, good collateral circulations were observed in 51.9% (n=140) of CAD patients, whereas poor collateral circulations were ound in 48.1% (n=130) of patients. Poor CCC was significantly associated with hypertension (OR=3, 95%CI= 0.111-8.231, p = .001) and VFI (OR=2, 95%CI= 1.451-3.567, p =.001). ROC analysis revealed a VFI &gt; 9 to be a potential predictor of poor CCC with AUC=0.9, sensitivity of 95.00% and specificity of 86%. Conclusion: The current study concluded that greater VFI and concomitant hypertension considerably increase the likelihood of having poor CCC, therefore, visceral adiposity can be considered as a potential target for preventing poor collateral circulation in patients with established cardiac disease.

The effect of interarm blood pressure difference on coronary collateral flow in patients with ST-segment elevation myocardial infarction who had undergone primary percutaneous coronary intervention.

In patients with acute myocardial infarction, coronary collateral circulation (CCC) is associated with reduced infarct size, preserved cardiac function, and decreased mortality. An interarm blood pressure difference (IABPD) is shown to be independently associated with cardiovascular and all-cause of mortality. We aimed to determine the effect of IABPD on coronary collateral flow in patients with ST-segment elevation myocardial infarction (STEMI) who had undergone primary percutaneous coronary intervention (p-PCI). We prospectively investigated 1,348 consecutive patients who were hospitalized for STEMI and underwent p-PCI. The Rentrop classification was used to assess CCC. According to this classification, we defined Rentrop 0 and 1 as poor CCC, and Rentrop 2 and 3 as good CCC. A 10 mm Hg difference is considered the upper limit of IABPD. Patients were divided into two groups according to the collateral circulation, 325 patients (24%) had good collateral, while 1,023 patients (76%) had poor collateral. IABPD was significantly higher in the poor collateral group (57 patients, 5.6%) than in the good collateral group (9 patients, 2.8%) (p=0.04). Pre-infarction angina and IABPD were identified as independent predictors of poor collateral (OR: 0.516, 95% CI 0.370-0.631, p=0.007; OR: 3.681, 95% CI: 1.773-7.461, p=0.01, respectively) in multivariate analysis. The IABPD was shown as an independent predictor of poor collateral circulation in patients with STEMI who underwent p-PC.

Hyperinsulinemia Impaired Coronary Collateral Circulation in Patients with Chronic Total Coronary Occlusion.

Hyperinsulinemia impaired cardiovascular system and endothelial function in the population. The purpose of this study was to explore the relationship between hyperinsulinemia and coronary collateral circulation in patients with chronic total coronary occlusion. Patients with stable angina and at least one total coronary occlusion were enrolled in this study. Collateral grade was determined according to Rentrop's classification. Patients were divided into a good coronary collateral circulation (CCC) group (grade 2 or 3 collateral vessels, n = 223) and a poor CCC group (grade 0 or 1 collateral vessels, n = 115). Fasting insulin level (FINS) and fasting glucose level (FBS) were measured. Endothelial function evaluated by flow-mediated dilation (FMD). Serum FINS level was significantly increased in the poor CCC group (P < 0.01). Patients in the poor CCC group had higher levels of FBS, HbA1C, and homeostasis model assessment for insulin resistance (HOMA-IR) than patients in the good CCC group. The poor CCC group also had lower levels of FMD, lower LVEF and higher syntax scores than the good CCC group. Hyperinsulinemia (T3, FINS ≥15.22 μIU/mL) increased OR for the incidence of the poor CCC group (OR 2.419, 95% CI 1.780-3.287) in multivariate analysis. Multivariate logistic regression also revealed that diabetes, HbA1c, HOMA-IR, HDL-C and Syntax score were independent predictors of poor CCC (all P < 0.05). Hyperinsulinemia is a valuable predictor of poor collateral formation in patients with chronic total coronary occlusion.

The impact of the apelinergic system in coronary collateral formation.

This study aims to examine the relationship between the development of coronary collateral circulation and serum elabela levels. Between January 2020 and December 2021, a total of 50 control individuals (29 males, 21 females; mean age: 63.2±10.0 years; range, 52 to 73 years) with no significant coronary artery disease as confirmed by angiography (Group 1) and 100 patients (55 males, 45 females; mean age: 66.6±9.6 years; range, 56 to 75 years) with coronary artery disease were included. The patients were further divided into two equal groups according to the Rentrop classification as poor (Group 2) and good coronary collateral circulation (Group 3). All groups were compared in terms of several parameters, particularly serum elabela levels. Serum elabela levels were found to be statistically higher in the group with good collateral than the other groups (p<0.05). Low serum elabela levels increased the risk of developing weak collaterals by 2.43 times. The elabela protein is directly related to good collateral development and can be considered a potential agent for treatment.

The association of serum uric acid/albumin ratio with the development of coronary collateral circulation in patients with chronic total occluded coronary arteries.

Introduction: Coronary collateral circulation (CCC) develops in chronic total occluded (CTO) vessels and protects the myocardium against ischemia in addition to the improvement of cardiac functions. Poor CCC is related to adverse cardiac events as well as poor prognosis. Serum uric acid/albumin ratio (UAR) has emerged as a novel marker associated with poor cardiovascular outcomes. We aimed to investigate whether there was an association between UAR and poor CCC in CTO patients. Methods: This study was comprised of 212 patients with CTO (92 with poor CCC and 120 with good CCC). All patients were graded based on Rentrop scores to poor CCC (Rentrop scores 0 and 1) and good CCC (Rentrop scores 2 and 3). Results: Poor CCC patients had higher frequencies of diabetes mellitus, triglyceride levels, Syntax and Gensini scores, uric acid, and UAR and lower lymphocyte, high-density lipoprotein cholesterol, and ejection fraction when compared to good CCC patients. UAR was an independent predictor of poor CCC in CTO patients. Furthermore, UAR had a better discriminative ability for patients with poor CCC from good CCC compared to serum uric acid and albumin. Conclusion: Based on the results of the study, the UAR could be used to detect poor CCC in CTO patients.

Good coronary collateral circulation is not associated with better prognosis in patients with chronic total occlusion, regardless of treatment strategy

ObjectiveThis study aimed to assess the effects of coronary collateral circulation (CCC) on the prognosis of patients with chronic total occlusion (CTO) under different treatment strategies. MethodsWe analyzed a total of 1124 patients who were diagnosed with CTO and divided them into groups with good CCC (grade 2 to 3, n = 539) or poor CCC (grade 0 to 1, n = 531). The primary outcome was cardiac death during follow-up; the secondary outcome was major adverse cardiovascular events (MACEs). We also performed subgroup analyses in groups with and without CTO revascularization (CTO-R and CTO-NR, respectively), and sensitivity analyses excluding patients who received failed CTO-PCI to further investigate the effect of CCC. ResultsDuring a median follow-up duration of 23 months, we did not detect any significant differences between the good CCC group and the poor CCC group in terms of cardiac death (4.2% vs 4.1%; adjusted hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.56–1.83; p = 0.970) and MACEs (23.6% vs 23.2%; adjusted HR, 1.07; 95% CI, 0.84–1.37; p = 0.590). Subgroup analyses according to CTO revascularization showed similar results. In addition, we observed no differences in sensitivity analyses when patients who received failed CTO-PCI were excluded. ConclusionGood CCC was not associated with a lower risk of cardiac death or MACEs among patients with CTO, regardless of whether the patients received CTO revascularization treatment.

Differentially hypomethylated cell-free DNA and coronary collateral circulation

BackgroundThe factors affecting cardioprotective collateral circulation are still incompletely understood. Recently, characteristics, such as CpG methylation of cell-free DNA (cfDNA), have been reported as markers with clinical utility. The aim of this study was to evaluate whether cfDNA methylation patterns are associated with the grade of coronary collateral circulation (CCC).ResultIn this case–control study, clinical and angiographic data were obtained from 143 patients (mean age, 58 years, male 71%) with chronic total coronary occlusion. Enzymatic methyl-sequencing (EM-seq) libraries were prepared using the cfDNA extracted from the plasma. Data were processed to obtain the average methylation fraction (AMF) tables of genomic regions from which blacklisted regions were removed. Unsupervised analysis of the obtained AMF values showed that some of the changes in methylation were due to CCC. Through random forest preparation process, 256 differentially methylated region (DMR) candidates showing strong association with CCC were selected. A random forest classifier was then constructed, and the area under the curve of the receiver operating characteristic curve indicated an appropriate predictive function for CCC. Finally, 20 DMRs were identified to have significantly different AMF values between the good and poor CCC groups. Particularly, the good CCC group exhibited hypomethylated DMRs. Pathway analysis revealed five pathways, including TGF-beta signaling, to be associated with good CCC.ConclusionThese data have demonstrated that differential hypomethylation was identified in dozens of cfDNA regions in patients with good CCC. Our results support the clinical utility of noninvasively obtained epigenetic signatures for predicting collateral circulation in patients with vascular diseases.

Study to relate of the coronary collareral circulation with major adverse cardiac events after percutatnenous coronary invervention in st-elevation myocardial infarction

Background: The presence of good coronary collateral circulation (CCC) can protect and preserve myocardium from ischemia, increase myocardial contractility, and reduce adverse clinical events. However, its impact on mortality is still a topic of debate, particularly in acute coronary syndrome (ACS). The aim of this study was to investigate the association of CCC with cardiac risk factors and in-hospital mortality in patients hospitalized with a diagnosis of ACS.&#x0D; Methods: The study population included 200 patients with ST – elevation myocardial infrarction who underwent coronary angiography and were found to have TIMI flow coronary 0 or 1. The CCC was graded according to the Rentrop classification. The patients were classified into a poor CCC group (Rentrop grades 0-1, n=161) or a good CCC group (Rentrop grades 2-3, n=39). Following of major adverse cardiac events about 30day after PCI.&#x0D; RESULTS: Patients with good CCC had time onset chest pains (p = 0,001), higher rate of Killip class of at least 2 at admission (p = 0,031), peak troponin T (p = 0,037), lacticemia lower (p = 0,03), multivessel lesion upper (p = 0,03) with the patients with poor CCC. MACE of patients with good CCC nosignificant with the patient with poor CCC (OR=3,9, 95%CI[0,5- to 30,5], mortality (HR 2,5, 95%CI[0,31-19,2], p=0,45), unplanned target vessel revascularisation (TVR) (HR 28,8 (0.006 to 1.4), p=0.44), comelack in-hospital by cardiovascular causes (HR 1,06, 95%CI[0,29 to 3,7]. P=0,93). Increase left ventricular ejection fraction after 30day in patients with good CCC upper patients with poor CCC (p=0,004).&#x0D; CONCLUSION: In contrast to previous studies, our study did not confirm a beneficial role of good CCC in patients with ST – elevation myocardial infarction. The presence of good CCC was even independently associated NYHA grades, Killip grades, peak troponin T, lacticemia and left ventricular ejection fraction.

The relationship between mean platelet volume lymphocyte ratio and collateral circulation in patients with chronic total coronary occlusion.

To correlate mean platelet volume lymphocyte ratio (MPVLR) and coronary collateral circulation (CCC) in patients with chronic total occlusion (CTO). A total of 643 patients who were hospitalized at a single large academic medical center from January 2020 to October 2021 and had CTO lesions in at least one major coronary artery confirmed by coronary angiography were retrospectively analyzed. Patients were divided according to the Rentrop criteria into poorly formed CCC (Rentrop grade 0-1, n = 235) and well-formed CCC (Rentrop grade 2-3, n = 408) groups. Mean platelet volume lymphocyte ratio (MPVLR) was calculated from routine laboratory data (MPV divided by lymphocyte count). The clinical data of the two groups were compared, and relationships between MPVLR and CCC formation were analyzed. The MPVLR of patients with poorly formed CCC was significantly higher than that of patients with well-formed CCC (7.82 ± 3.80 vs. 4.84 ± 1.42, P < 0.01). The prevalence of diabetes mellitus and C-reactive protein levels were significantly higher in the poor CCC group than in the good CCC group (P < 0.01), while the proportions of patients with CTO or multivessel lesions in the right coronary artery were significantly lower in the poor CCC group than in the good CCC group (P < 0.01). Multivariate logistic regression analysis identified MPVLR (OR: 2.101, 95% CI: 1.840-2.399, P < 0.01), C-reactive protein level (OR: 1.036, 95% CI: 1.008-1.064, P < 0.05), a history of diabetes mellitus (OR: 2.355, 95% CI: 1.532-3.621, P < 0.01), and right coronary CTO ratio (OR: 0.313, 95% CI: 0.202-0.485, P < 0.01) as independent risk factors for CCC formation. The area under the ROC curve of MPVLR for predicting poorly formed CCC was 0.82 (95% CI: 0.784-0.855, P < 0.01), the best cut-off point was 6.02 and the sensitivity and specificity of MPVLR for predicting poorly formed CCC were 72.3 and 82.4%, respectively. In patients with coronary CTO, MPVLR was negatively correlated with CCC and a high MPVLR level was an independent predictor of poorly formed CCC.

LncRNA PVT1 is a novel mediator promoting the angiogenesis response associated with collateral artery formation.

Angiogenesis plays a key role in coronary collateral circulation (CCC), the compensatory formation of new blood vessels during chronic total coronary occlusion. This study aimed to determine whether plasmacytoma variant translocation 1 (PVT1), a long non-coding (lnc) RNA involved in tumor angiogenesis, plays a role in regulating angiogenesis during chronic coronary ischemia. Patients with coronary artery disease, and ≥90% stenosis, were examined and divided into "Good" and "Poor" CCC groups based on Rentrop Cohen classification. RNA samples were obtained from all patients, as well as from oxygen and glucose-deprived (OGD) HUVECs. PVT1, miR-15b-5p and AKT3 levels were measured with RT-qPCR or Western blot, while HUVEC migration and angiogenesis were detected by, respectively, wound-healing and tube formation assays. Luciferase reporter assay confirmed direct PVT1-miR-15b-5p binding. Increased PVT1 was found in "Good CCC" patient plasma, along with being highly expressed among OGD HUVECs; PVT1 knockdown reduced HUVEC migration, tube formation, and pro-angiogenic factor expression. Conversely, OGD HUVECs had downregulated miR-15b-5p, and miR-15b-5p overexpression significantly depressed their angiogenic capabilities. These PVT1 knockdown- or miR-15b-5p overexpression-associated reductions in angiogenic effects were reversed by AKT3 overexpression. In vivo, neovascularization and functioning in both ischemic mice hind-limbs and infarcted myocardium injected with ADV-sh-PVT1 were reduced, which were ameliorated by concurrent antagomiR-15b-5p injections. Circulating PVT1 may serve as a useful biomarker to distinguish between good versus poor CCC, as it is involved in orchestrating angiogenesis via the miR-15b-5p-AKT3 axis; it thus has potential as a target for treating ischemic disease.

Assessment of the Relationship Between the Adropin Levels and the Coronary Collateral Circulation in Patients wıth Chronic Coronary Syndrome.

ResumoFundamento A circulação colateral coronária (CCC) proporciona um fluxo sanguíneo alternativo a tecido miocárdico exposto a isquemia e ajuda a preservar as funções miocárdicas. A produção endotelial de óxido nítrico (NO) e o fator de crescimento endotelial vascular (VEGF) foram apontados como os fatores mais importantes no desenvolvimento da CCC. A adropina é um hormônio peptídeo responsável pela hemostasia energética, e é conhecida por seus efeitos positivos no endotélio por NO e VEGF.Objetivo O objetivo deste estudo é investigar a associação entre adropina e a presença de CCC em pacientes com síndrome coronariana crônica (SCC)Métodos Um total de 102 pacientes com SCC, que tinham oclusão total de pelo menos 1 artéria coronária epicárdica importante, foram incluídos no estudo e foram divididos em dois grupos: o grupo de pacientes (n: 50) com CCC ruim (Rentrop 0-1) e o grupo de pacientes (n: 52) com CCC boa (Rentrop 2-3). O nível de significância adotado para a análise estatística foi 5%.Resultados Os níveis médios de adropina identificados foram 210,83±17,76 pg/mL e 268,25±28,94 pg/mL nos grupos com CCC ruim e boa, respectivamente (p<0,001). Detectou-se que os níveis de adropina têm correlação com as razões neutrófilo-linfócito (r: 0,17, p: 0,04) e com os escores de Rentrop (r: 0,76, p<0,001), e correlação negativa com idade (r: -0,23, p: 0,01) e com os escores Gensini (r: -0,19, p: 0,02). O nível de adropina é um preditor independente da boa evolução da CCC (RC: 1.12, IC 95%: (1,06–1,18), p<0,001).Conclusão Este estudo sugere que os níveis de adropina podem ser um fator associado à de CCC em pacientes com SCC.

Relationship between Systemic Immune-Inflammation Index and Coronary Collateral Circulation in Patients with Chronic Total Occlusion.

ResumoFundamento A inflamação desempenha um papel fundamental no início e na progressão da doença arterial coronariana (DAC). O Índice Imune-inflamação Sistêmico (SII) é um novo parâmetro inflamatório que demonstrou estar associado à DAC.Objetivos Este estudo teve como objetivo investigar a relação entre o SII e a circulação colateral coronariana (CCC) em pacientes com DAC estável e oclusão crônica total (OTC).Métodos Os pacientes foram divididos em dois grupos, com CCC deficiente e CCC boa, de acordo com a Classificação Rentrop. Noventa e quatro pacientes apresentavam CCC deficiente e 81 pacientes CCC boa. Os parâmetros de inflamação foram calculados a partir dos resultados laboratoriais. O nível de significância estatística aplicado foi de 0,05.Resultados Alto nível de SII (OR: 1,003, IC 95%: 1,001-1,004, p<0,001), ausência de OTC na ACD (artéria coronária direita) (OR: 0,204, IC 95%: 0,096-0,436, p<0,001) e baixo escore de Gensini (OR: 0,980, IC 95%: 0,962-0,998, p=0,028) foram significantemente associados com CCC deficiente. O valor de corte do SII foi de 679,96 para o maior poder preditivo de CCC deficiente, com sensibilidade de 74,5% e especificidade de 43,2%. As taxas de mortalidade foram semelhantes entre os dois grupos durante um seguimento médio de 21,5±10,8 meses (p=0,107).Conclusões Alto nível de SII, ausência de OTC na artéria coronária direita e baixo escore de Gensini foram significantemente relacionados à CCC deficiente. O uso rápido e custo-efetivo de novos marcadores inflamatórios na prática clínica orienta o prognóstico da DAC.

The prognostic value of the CHA2DS2-VASc score in coronary collateral circulation and long-term mortality in coronary artery disease.

The CHA2DS2-VASc score is used to determine thromboembolic risk in cases of atrial fibrillation. The predictive value of this score in predicting coronary collateral circulation in chronic total occlusion is unknown. The aim of this study was to investigate the relationship between the CHA2DS2-VASc score and coronary collateral circulation in patients with chronic total occlusion. A total of 189 patients, who underwent coronary angiography and had a chronic total occlusion in at least one coronary artery, were enrolled in this study. The Rentrop scoring system was used for grouping the patients, and patients were classified as having poorly developed coronary collateral circulation (Rentrop grade 0 or 1) or well-developed coronary collateral circulation (Rentrop grade 2 or 3). The CHA2DS2-VASc score of the good coronary collateral circulation group was significantly lower than the other group (3.1±1.7 vs. 3.7±1.7, p=0.021). During the follow-up period, 30 (32.2%) patients in the poorly developed coronary collateral circulation group and 16 (16.7%) patients in the well-developed coronary collateral circulation group died (p=0.028). According to the multivariable Cox regression model, the CHA2DS2-VASc score [hazard ratio (HR): 1.262, p=0.009], heart rate (HR: 1.049, p=0.003), LVEF (HR: 0.975, p=0.039), mean platelet volume (HR: 1.414, p=0.028), and not taking acetylsalicylic acid during admission (HR: 0.514, p=0.042) were independently associated with a higher risk of mortality. The CHA2DS2-VASc score is closely related to coronary collateral development and predicts mortality in patients with chronic total occlusion.

Frequency of Poor &amp; Good Coronary Collateral Circulation in patients of Non-ST Segment Elevation Myocardial Infarction &amp; to compare mean Platelet –Lymphocyte ratio with good &amp; poor coronary collateral circulation

Background: Coronary collateral circulation (CCC) is a secondary source of blood supply to an ischemic myocardial area in coronary artery disease. One of the most important protective responses of the cardiac against ischemia is the development of CCC. Recently, platelet to lymphocyte ratio has emerged as a major inflammatory marker &amp; a new predictor of serious unfavorable cardiovascular outcomes. Aim: To find the frequency of poor &amp; good coronary collateral circulation in patients of Non-ST Segment Elevation Myocardial Infarction &amp; to compare mean platelet–lymphocyte ratio in patients with poor &amp; good coronary collateral circulation of Non-ST Segment Elevation Myocardial Infarction. Methodology: This cross Sectional study was conducted in Cardiology Department, Mayo Hospital Lahore After taking informed consent 150 patients meeting inclusion criteria was taken in this study. The patients were enrolled from Department Cardiology, Mayo Hospital Lahore. Their basic demographical information like age, gender and contact detail was obtained. Patients were labeled as according to CCC, one with Poor CCC and second with good CCC [as per operational definition]. All procedure was done by consultant cardiologist having more than 5 years of experience after post-graduation. Venous blood was collected from patients in sterilized manners by experienced staff nurse and was sent to hospital laboratory for analysis of PLR. PLR was compared in cases with good and poor CCC. Results:1The average age of cases was 52.41 ± 18.12 years with minimum and maximum age of 20 and 80 years. There were 96(64%) male and 54(36%) female cases in this study. A total of 33 (22%) cases had poor and 117(78%) cases had good CCC. The mean Platelet-to-lymphocyte ratio (PLR) was 122.16 ± 30.10 with minimum and maximum PLR was 80.64 and 201.60. The mean PLR in cases with poor and good CCC was 165.95±21.93 and 109.81 ± 18.21 respectively, the mean PLR was highly significant in cases with Poor CCC when compared with good CCC, p-value &lt; 0.0001. Conclusion: This study concludes that cases with poor CCC have higher PLR when compared to good CCC, so in future cases with higher PLR at admission can be predict for high risk patients for poor CCC. Using PLR (inexpensive and readily available) test we can hence, patients with NSTEMI can be prevented from morbidity &amp; mortality by early and appropriate medications or interventions. Keywords Cardiology, Angiography, coronary artery disease, Low ejection fraction, coronary collateral circulation.

Visfatin and 25-Hydroxyvitamin D3 Levels Affect Coronary Collateral Circulation Development in Patients with Chronic Coronary Total Occlusion

Background: Coronary collateral circulation (CCC) plays a vital role in the myocardial blood supply, especially for ischemic myocardium. Evidence suggests that the visfatin and 25-hydroxyvitamin D3 [25(OH)D3] levels are related to the degree and incidence of vascular stenosis associated with coronary artery disease; however, few studies have evaluated the effect of visfatin and 25(OH)D3 on CCC development in patients with chronic total occlusion (CTO). This study aimed to evaluate the relationship between the serum visfatin and 25(OH)D3 levels and CCC in patients with CTO. Methods: A total of 189 patients with CTO confirmed by coronary angiography were included. CCC was graded from 0 to 3 according to the Rentrop-Cohen classification. Patients with grade 0 or grade 1 collateral development were included in the poor CCC group (n=82), whereas patients with grade 2 or grade 3 collateral development were included in the good CCC group (n=107). The serum visfatin and 25(OH)D3 levels were measured by ELISA. Results: The visfatin level was significantly higher in the poor CCC group than in the good CCC group, and the 25(OH)D3 level was significantly lower in the poor CCC group than in the good CCC group (P=0.000). Correlation analysis showed that the Rentrop grade was negatively correlated with the visfatin level (r=−0.692, P=0.000) but positively correlated with the 25(OH)D3 level (r=0.635, P=0.000). Logistic regression analysis showed that the visfatin and 25(OH)D3 levels were independent risk factors for CCC (odds ratio 1.597, 95% confidence interval 1.300–1.961, P=0.000 and odds ratio 0.566, 95% confidence interval 0.444–0.722, P=0.000, respectively). The visfatin and 25(OH)D3 levels can effectively predict the CCC status. Conclusion: Serum visfatin and 25(OH)D3 levels are related to CCC development and are independent predictors of poor CCC.

The association of interferon-alpha with development of collateral circulation after artery occlusion.

BackgroundPrevious studies have demonstrated that interferon (IFN) signaling is enhanced in patients with poor collateral circulation (CC). However, the role and mechanisms of IFN‐alpha in the development of CC remain unknown.MethodsWe studied the serum levels of IFN‐alpha and coronary CC in a case–control study using logistics regression, including 114 coronary chronic total occlusion (CTO) patients with good coronary CC and 94 CTO patients with poor coronary CC. Restricted cubic splines was used to flexibly model the association of the levels of IFN‐alpha with the incidence of good CC perfusion restoration after systemic treatment with IFN‐alpha was assessed in a mice hind‐limb ischemia model.ResultsCompared with the first IFN‐alpha tertile, the risk of poor CC was higher in the third IFN‐alpha tertile (OR: 4.79, 95% CI: 2.22–10.4, p < .001). A cubic spline‐smoothing curve showed that the risk of poor CC increased with increasing levels of serum IFN‐alpha. IFN‐alpha inhibited the development of CC in a hindlimb ischemia model. Arterioles of CC in the IFN‐alpha group were smaller in diameter than in the control group.ConclusionPatients with CTO and with poor CC have higher serum levels of IFN‐alpha than CTO patients with good CC. IFN‐alpha might impair the development of CC after artery occlusion.

Cholesterol Efflux and Collateral Circulation in Chronic Total Coronary Occlusion: Effect-Circ Study.

BackgroundThe mechanism through which high‐density lipoprotein (HDL) induces cardioprotection is not completely understood. We evaluated the correlation between cholesterol efflux capacity (CEC), a functional parameter of HDL, and coronary collateral circulation (CCC). We additionally investigated whether A1BP (apoA1‐binding protein) concentration correlates with CEC and CCC.Methods and ResultsIn this case‐control study, clinical and angiographic data were collected from 226 patients (mean age, 58 years; male, 72%) with chronic total coronary occlusion. CEC was assessed using a radioisotope and J774 cells, and human A1BP concentration was measured using enzyme‐linked immunosorbent assay. Differences between the good and poor CCC groups were compared, and associations between CEC, A1BP, and other variables were evaluated. Predictors of CCC were identified by multivariable logistic regression analysis. The CEC was higher in the good than in the poor CCC group (22.0±4.6% versus 20.2±4.7%; P=0.009). In multivariable analyses including age, sex, HDL‐cholesterol levels, age (odds ratio [OR], 0.96; P=0.003), and CEC (OR, 1.10; P=0.004) were identified as the independent predictors of good CCC. These relationships remained significant after additional adjustment for diabetes mellitus, acute coronary syndrome, and Gensini score. The A1BP levels were not significantly correlated with CCC (300 pg/mL and 283 pg/mL in the good CCC and poor CCC groups, respectively, P=0.25) or CEC.ConclusionsThe relationship between higher CEC and good CCC indicates that well‐functioning HDL may contribute to CCC and may be cardioprotective; this suggests that a specific function of HDL can have biological and clinical consequences.