Poor Coronary Collateral Circulation Group Research Articles

Association between the atherogenic index of plasma and coronary collateral circulation in patients with chronic total occlusion

BackgroundThe atherogenic index of plasma (AIP) is considered an independent risk factor for coronary artery disease (CAD). The present study investigated whether AIP correlates with the formation of coronary collateral circulation (CCC) in CAD patients with chronic total occlusion (CTO).MethodsThis retrospective study included 1093 CAD patients with CTO confirmed by coronary angiography from January 2020 to December 2020 at Beijing Anzhen Hospital. Based on the Rentrop scoring system, the patients were divided into the good CCC group and the poor CCC group. AIP was calculated by log (triglyceride/high-density lipoprotein cholesterol). Meanwhile, the study population was further divided into four groups according to the quartiles of AIP.ResultsPatients in the poor CCC group exhibited significantly higher AIP compared to those in the good CCC group (0.31 ± 0.27 vs. 0.14 ± 0.24, p < 0.001). Multivariate logistic regression analysis revealed an independent association between AIP and poor CCC, regardless of whether AIP was treated as a continuous or categorical variable (p < 0.001), after adjusting for confounding factors. Besides, this association remained consistent across most subgroups. The incorporation of AIP into the baseline model significantly enhanced the accuracy of identifying poor CCC [area under the curve (AUC): baseline model, 0.661 vs. baseline model + AIP, 0.721, p for comparison < 0.001].ConclusionsElevated AIP is independently associated with an increased risk of poor CCC in CAD patients with CTO, and AIP may improve the ability to identify poor CCC in clinical practice.

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.

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.

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.

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.

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.

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.

Association of lower serum irisin levels with diabetes mellitus: Irrespective of coronary collateral circulation, and syntax score.

Objective:Irisin is a myokine thought to be involved in the pathophysiological process of atherosclerosis with its’ cardiovascular protective effects. Patients with diabetes mellitus (DM) have lower levels of irisin. Therefore, we investigated whether there is a connection between irisin, DM, coronary collateral circulation (CCC), and SYNTAX scores representing coronary artery disease (CAD) severity.Methods:This study evaluated 86 patients who have at least one epicardial coronary artery with chronic total occlusion. We included Rentrop 0–1 into the poor CCC group (n=45) and Rentrop 2–3 into the good CCC group (n=41) and measured serum irisin levels.Results:Irisin levels did not differ (17585 [882–37741] pg/ml and (17504 [813–47683] pg/ml, p=0.772) between the two groups. Irisin levels were lower in patients with diabetes (n=41; 14485 [813–29398] pg/ml) than those without diabetes (n=45; 19724 [865–47683] pg/ml (p=0.002). Irisin was not correlated with SYNTAX scores. In multivariate analysis, DM (OR=0.463; CI: 0.184–0.783; p=0.012) was a negative predictor of good CCC developmentConclusion:Although its level is decreased in patients with diabetes, serum irisin levels have no role in the pathophysiology of collateral development and CAD severity.

The Effects of Preoperative Coronary Collateral Circulation on Cardiac-Related Events after Coronary Artery Bypass Graft Surgery.

IntroductionThis study aimed to evaluate the effects of coronary collateral circulation (CCC) in patients who had undergone coronary artery bypass grafting (CABG).MethodsA total of 127 patients who had undergone CABG (2011-2013) were enrolled into this study and follow-up was obtained by phone contact. Patients were categorized into two groups according to preoperative CCC using the Rentrop method. Percutaneous coronary intervention (PCI), recurrent myocardial infarction (MI), stroke, heart failure (HF), and mortality rates were compared between groups. Clinical outcome was defined as combined end point including death, PCI, recurrent MI, stroke, and HF.ResultsSixty-two of 127 patients had poor CCC and 65 had good CCC. There were no differences in terms of PCI, recurrent MI, and HF between the groups. Stroke (seven of 62 [11.3%] and one of 65 [1.5%], P=0.026) and mortality (19 of 62 [30.6%] and 10 of 65 [15.4%], P=0.033) rates were significantly higher in poor CCC group than in good CCC group. In Kaplan-Meier analysis, survival time was not statistically different between the groups. Presence of poor CCC resulted in a significantly higher combined end point incidence (P=0.011).ConclusionStroke, mortality rates, and combined end point incidence were significantly higher in poor CCC patients than in the good CCC group.

Correlation of plasma vitamin D levels with coronary collateral circulation

Introduction: In patients with coronary chronic total occlusion (CTO), adequate coronary collateral circulation (CCC) supports myocardial tissue versus ischemia. Vitamin D deficiency is a risk factor for osteoporosis and other chronic diseases, including type 1 diabetes, hypertension, metabolic syndrome and ischemic heart disease. Objectives: In this study, we evaluated whether coronary CTO is associated with serum levels of vitamin D and CCC. Patients and Methods: Around 216 patients with coronary CTO at coronary angiography were incorporated in this investigation. Serum 25(OH)D level and low-density lipoprotein (LDL-C), triglyceride (TG), total cholesterol, fasting blood sugar (FBS), serum creatinine, high-density lipoprotein (HDL-C), were assessed before angiography. Patients were divided into a poor coronary collateral circulation group (Rentrop grades 0-1) or good coronary collateral circulation group (Rentrop grades 2-3). Results: A total of 216 patients (mean age 61.48±9.5 years) were included in this study. Regression analysis results displayed that serum 25(OH)D level had a significant correlation with CCC according to Rentrop scoring system (P&lt;0.0001). We also found that variables such as gender (P=0.05), HDL-C (P=0.01) and serum creatinine (P=0.05) were a predictor for CCC. This model described 33% of the CCC’s variance in the study patients. Besides, in the analysis of clinical levels of vitamin D, it can be stated that the probability of having a high degree of Rentrop criterion in the patients with adequate level of vitamin D is 24.5 times higher than the patients with vitamin D deficiency (P&lt;0.001). Conclusion: The results of this study emphasize the importance of informing patients with CTO commonly associated with serum vitamin D level.

Correlation between ischemia-modified albumin level and coronary collateral circulation

ObjectiveTo investigate the correlation between ischemia-modified albumin (IMA) levels and coronary collateral circulation (CCC) in patients with chronic total occlusive (CTO).MethodsCoronary angiography was performed in the Department of Cardiology, Zhongnan Hospital of Wuhan University from 2017 to 08 to 2019–02 to identify 128 patients with CTO lesions in at least one major coronary artery. According to the Rentrop evaluation criteria, the degree of CCC formation was divided into the poor CCC formation group (Rentrop0–1 grade,n = 69) and the good CCC formation group (Rentrop2–3 grade,n = 59). The IMA level of the patients was measured using an albumin-cobalt binding assay. The general data, routine blood panel, total bilirubin (TBIL), blood lipids, uric acid (UA), left ventricular ejection fraction (LVEF) and other indicators of the patients were recorded and analyzed while assessing the patients’ blood vessel occlusion.ResultsThe proportion of platelet count and diabetes in the poor CCC group was higher than that in the good CCC group (P < 0.05). The ratio of ischemia-modified albumin and total bilirubin in the poor CCC group was lower than that in the good CCC group (P < 0.05). Multivariate logistic regression analysis showed that ischemia-modified albumin was positively correlated with CCC formation [OR = 1.190,95% CI (1.092–1.297),P < 0.001], while diabetes was negatively correlated with CCC formation [OR = 0.285,95% CI (0.094–0.864), P < 0.05]. Ischemic modified albumin predicted good formation of CCC according to the ROC curve, and the area under the ROC curve was 0.769(95% CI,0.686–0.851, P<0.001); the optimal cut-off value was 63.35 KU/L, and the sensitivity was 71.2%,specificity is 71%.ConclusionThe IMA level is closely related to good formation of CCC. Higher IMA levels can be used as an effective predictor of good CCC formation in patients with CTO.

The Relationship Between Circulating Neuregulin-1 and Coronary Collateral Circulation in Patients with Coronary Artery Disease.

Coronary collateral circulation (CCC) plays a crucial role in myocardial blood supply, especially for ischemic myocardium. Previous study has shown that neuregulin-1 is a prominent angiogenic factor in diabetic cardiomyopathy, whereas the relationship between neuregulin-1 and CCC has not been investigated. Thus, we aimed to investigate relationship between circulating neuregulin-1 levels and CCC in stable coronary artery disease patients.Coronary artery disease patients with a stenosis of ≥ 90% as evidenced by coronary angiography were included in our study. According to the Rentrop-Cohen classification, coronary collateral degree was graded as 1 to 4. Patients with collateral degree grade 0 or 1 were enrolled in poor CCC group, whereas patients with grade 2 or 3 were enrolled in good CCC group.Plasma neuregulin-1 level was significantly increased in good collateral group and positively related to Rentrop grade (P < 0.01). Multivariate regression analysis and ROC (receiver operating characteristic curve) revealed that plasma neuregulin-1 could predict CCC status effectively.Increased plasma neuregulin-1 level was related to better CCC in patients with coronary artery disease. Neuregulin-1 was an independent and reliable predictor for good coronary collateral development and provided a potential therapeutic strategy to reduce myocardial ischemia injury.

Impact of Coronary Collateral Circulation of Perioperative Myocardial Damage in High-Risk Patients Undergoing Coronary Artery Bypass Grafting Surgery.

Coronary collateral circulation (CCC) is a small vascular formation that allows the connection between the different parts of an epicardial vessel or other vessels. The presence of collateral circulation contributes positively to the course of coronary artery disease (CAD). The aim of this study was to investigate the effect of collateral circulation on myocardial injury and clinical outcomes during coronary artery bypass grafting (CABG) in a high-risk patient group. 386 patients who underwent isolated CABG under cardiopulmonary bypass (CPB) were included in the study. Patients were divided into two groups according to the Rentrop scores (n = 225 poor CCC group; and n = 161 good CCC group). Myocardial injury and postoperative clinical results were evaluated as endpoints. The mean age was 62.9 ± 7.5 years, and 61.6% of all patients were male. Postoperative 30-day mortality rate was significantly higher in poor CCC group (4 [1.7%] and 1 [0.6%], P < .001). The frequency of postoperative intraaortic balloon pump (IABP) use (5 [2.2%] and 1 [0.6%], P < .001), low cardiac output syndrome (LCOS) (28 [12.4%] and 10 [6.2%], P < .001) and postoperative atrial fibrillation (35 [15.6%] and 16 [9.9%], P = .038) were significantly higher in poor CCC group. 12th and 24th hour CK-MB and cTn-I values were found to be significantly lower in the good CCC group. It is inevitable that the CPB circuit and operation have devastating effects on myocardium in CABG operations. The presence of CCC reduces postoperative myocardial injury, low cardiac output syndrome, and mortality rates.

Effect of coronary collateral circulation on the prognosis of elderly patients with acute ST-segment elevation myocardial infarction treated with underwent primary percutaneous coronary intervention.

Investigate the effect of coronary collateral circulation (CCC) on the prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) and acute total occlusion (ATO) of a single epicardial coronary artery.Three hundred forty-six advanced-age patients (age ≥60 years) with STEMI and ATO who underwent primary percutaneous coronary intervention (PCI) were enrolled in this study. According to the Rentrop grades, the patients were assigned to the poor CCC group (Rentrop grade 0–1) and good CCC group (Rentrop grade 2–3).Multivariate logistic regression analysis revealed that poor coronary collateral circulation was an independent factor for Killip class ≥2 (odds ratio [OR]: –1.559; 95% confidence interval [CI]: 1.346–2.378; P = .013), the use of an intra-aortic balloon pump (IABP) (OR: –1.302; 95% CI: 0.092–0.805; P = .019), and myocardial blush grade (MBG) 3 (OR: 1.516; 95% CI: 2.148–9.655; P < .001). We completed a 12-month follow-up, during which 52 patients (15.0%) were lost to follow-up and 19 patients (5.5%) died. Univariate analysis (Kaplan–Meier and log-rank tests) suggested that poor CCC had a significant effect on all-cause mortality (P = .046), while multivariate analysis (Cox regression analysis) indicated that CCC had no statistically significant effect on all-cause mortality (P = .089) after the exclusion of other confounding factors. After excluding the influence of other confounding factors, this study showed that the mortality rate increased by 26.9% within 1 year for every 1-hour increment of time of onset. The mortality rate in patients with Killip class ≥2 was 8.287 times higher than that in patients with Killip class 0 to 1. The mortality rate in patients over 75 years was 8.25 times higher than that in patients aged 60 to 75 years. The mortality rate in patients with myocardial blush grade 3 (MBG 3) was 5.7% higher than that in patients with MBG 0–2.The conditions of CCC in the acute phase had no significant direct effect on all-cause mortality in patients, but those with good CCC had a higher rate of MBG 3 after primary PCI and a lower rate of Killip ≥2.

Association between uric acid and coron ary collateral circulation in stable coronary artery disease patients

Objective The aim of this study was to investigate the association between serum uric acid levels and the development of coronary collateral circulation (CCC) in patients with stable coronary artery disease. Background Serum uric acid can cause atherosclerosis. High serum uric acid levels may be associated with poor CCC in patients with stable coronary artery disease. Patients and methods A cross-sectional study was carried out on 100 patients with stable CAD who underwent coronary angiography and documented total occlusion in one or more of the major coronary arteries in Cardiovascular Department Menoufia University Hospital during the period from 1 February 2016 to 30 January 2017. Development of CCC will be graded according to the Cohen–Rentrop method: grades 2–3 will be classified as good CCC (group A) and grades 0–1 as poor CCC (group B). Results A significant relationship between high level of serum uric acid and poor coronary collaterals was observed. Mean value of uric acid in group A was 4.72 ± 1.69 mg/dl and mean value of uric acid in group B was 6.68 ± 2.36 mg/dl (P Conclusion The measurement of uric acid level provides a good predictor of poor CCC in stable coronary artery disease patients.

The relationship of plasma miR-503 and coronary collateral circulation in patients with coronary artery disease

ObjectiveAlthough angiogenesis plays an important role in coronary collateral circulation (CCC) formation and there are many determinants of coronary angiogenesis, they cannot fully explain the mechanism of CCC formation or as potent biomarker for CCC status. Therefore, there is of great clinical significance to identify the novel molecules associated with CCC. Previously, miR-503 exerts anti-angiogenesis effect via inhibition of VEGF-A and its expression is associated with many angiogenesis-related factors. Thus, we aimed to investigate the relationship of plasma miR-503 with CCC formation as well as its predictive power for CCC status in patients with coronary artery disease. MethodsAmong patients who underwent coronary angiography with coronary artery disease and a stenosis of ≥90% were included in our study. Collateral degree was graded according to Rentrop Cohen classification. The patients were divided to good CCC group (grade 2 or 3) and poor CCC group (grade 0 or 1) according to Rentrop grade. We investigated the plasma levels of miR-503 and VEGF-A by ELISA or q RT-PCR, respectively. In addition, we assayed the correlations of plasma miR-503 with VEGF-A or Rentrop grade using the spearman correlation test and its predictive power by receiver operating characteristic (ROC) and binary logistical regression analysis. ResultsOur data showed that plasma VEGF-A was significantly higher in good CCC group than that in poor group. Plasma miR-503 was lower in CAD patients with good CCC or poor CCC compared with control subjects and lowest in good CCC group. In addition, miR-503 negatively correlated with VEGF-A and Rentrop grade, respectively. Moreover, miR-503 displayed more potent predictive power for CCC status than VEGF-A, but its sensitivity and specificity for CCC status were only 72.4 or 60.9%, respectively. ConclusionsLower plasma miR-503 level was related to better CCC formation, accompanied by up-regulation of VEGF-A. In addition, miR-503 displayed potent predictive power for CCC status, but its sensitivity and specificity were not high enough, indicating that miR-503 might be as an additional prognosis biomarker for CCC.

Prognostic value of coronary collaterals in patients with acute coronary syndromes.

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. The study population included 2286 patients with ACS who underwent coronary angiography and were found to have at least 90% significant lesion in at least one major coronary artery. The CCC was graded according to the Rentrop classification. The patients were classified into a poor CCC group (Rentrop grades 0-1, n=1859) or a good CCC group (Rentrop grades 2-3, n=427). Patients with good CCC had more high-risk patient characteristics such as older age, higher rate of Killip class of at least 2 at admission, lower left ventricular ejection fraction, and impaired renal functions compared with the patients with poor CCC. In multivariate analysis, the presence of good CCC [odds ratio (OR): 2.000; 95% confidence interval: 1.116-3.585; P=0.020], left ventricular ejection fraction less than 40% (OR: 2.381; P=0.003), Killip class of at least 2 at admission (OR: 3.609; P<0.001), age of at least 65 years (OR: 2.975; P=0.003), and hemoglobin (OR: 0.797; P=0.003) were independent predictors of in-hospital mortality. In contrast to previous studies, our study did not confirm a beneficial role of good CCC in patients with ACS; the presence of good CCC was even independently associated with increased in-hospital mortality in the multivariate analysis.

The relationship between fragmented QRS complex and coronary collateral circulation in patients with chronic total occlusion lesion without prior myocardial infarction

Objective: To explore the relationship between fragmented QRS complex(fQRS) and coronary collateral circulation(CCC) in patients with chronic total occlusion(CTO)lesion without prior myocardial infarction. Methods: This retrospective study analyzed 238 consecutive patients with CTO lesion in one of the major coronary arteries from May 2014 to October 2015 in our department. Patients were divided into poor CCC group (grade 0 and 1, 58 cases) and good CCC group(grade 2 and 3, 180 cases) based on Rentrop's classification of CCC. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous electrocardiogram leads corresponding to a major coronary artery territory. Multivariate logistic regression was used to analyze the relationship between CCC and fQRS on electrocardiogram. Results: Compared with good CCC group, patients in poor CCC group had older age((65.2±8.9)years old vs. (60.3±10.1) years old, P=0.03), higher plasma glucose ((7.22±3.00) mmol/L vs.(6.31±1.83)mmol/L, P=0.04), and lower left ventricular ejection fraction ((45.2±11.4)% vs. (51.2±13.5)%, P=0.02). None of patients had Rentrop grade 0, the presence of fQRS on ECG in patients with Rentrop grade 1, grade 2, and grade 3 CCC was 69.0% (40/58), 48.6% (35/72) , and 19.4% (21/108), respectively (P<0.01). The presence of fQRS were higher in poor CCC group than in good CCC group (69.0%(40/58)vs. 31.1%(56/180), P<0.01), and number of leads with fQRS were higher in poor CCC group than in good CCC group (3(0, 4)vs.0(0, 3), P<0.01). Multivariate logistic regression analysis demonstrated that poor CCC growth in patients with CTO lesion without prior myocardial infarction was independently related to the presence of fQRS (OR=3.659, 95%CI 1.619-8.217, P<0.01). Conclusion: Poor CCC in patients with CTO lesion without prior myocardial infarction is independently related to the presence of fQRS on electrocardiogram.

The correlation between lymphocyte/monocyte ratio and coronary collateral circulation in stable coronary artery disease patients.

Coronary collateral circulation (CCC) has an important impact on cardiovascular prognosisand well-developed CCC is associated with better clinical outcomes. We investigated whether lymphocyte/monocyte ratio (LMR) has an association with CCC in patients with stable coronary artery disease (SCAD). The study population consisted of 245 patients with SCAD. Patients were classified into a poor CCC group (Rentrop grades 0/1, n = 87), or good CCC group (Rentrop grades 2/3, n = 158). LMR values were significantly higher in patients with good CCC than in those with poor CCC (4.41 ± 1.58 vs 2.76 ± 1.10; p < 0.001). In receiver operating characteristic analysis, optimal cutoff of LMR for predicting well-developed CCC was 3.38. In multivariate analysis, LMR >3.38 (OR 4.637; p = 0.004), high sensitivity C-reactive protein (OR 0.810, p< 0.001), dyslipidemia (OR 2.485; p = 0.039), and presence of chronic total occlusion (OR 16.836; p< 0.001) were independent predictors of well-developed CCC. Increased LMR predicts well-developed CCC in SCAD patients.