| Background and ObjectiveChronic total coronary occlusive(CTO)disease is mainly a kind of thrombus formed by the rupture of vulnerable plaque caused by coronary atherosclerosis,at the same time,fibrosis,organization and calcium deposition occur in the thrombus,which leads to complete occlusion of the arterial lumen,and the occlusion lasts for more than 3 months.Coronary collateral circulation(CCC)means that there are many existing blood flow channels between coronary artery branches.when the coronary artery is completely occluded or severely stenosed,the anastomotic branches of coronary artery branches will open and gradually become a potential channel.This compensation can replace blocked blood vessels to some extent.The opening of collateral circulation can bypass blocked blood vessels or severely narrow blood vessels and reach the distal end of the occluded site to transport nutrients such as blood to severely ischemic myocardium.Both fibrinogen(FIG)and albumin(ALB)are produced by the liver.Related studies have shown that fibrinogen plays an important role in the formation and development of atherosclerosis.Other studies have shown that albumin has a protective effect on arterial vessels,and the incidence and mortality of cardiovascular disease increase significantly with the decrease of albumin level.Some studies have found that the ratio of fibrinogen to albumin(FAR)is related to inflammatory bowel disease,cancer metastasis,thromboembolic disease and prognosis.At present,there are few studies on the relationship between FAR and collateral circulation formation and prognosis in patients with CTO.Therefore,the purpose of this study was to explore the predictive value of admission FAR levels on collateral circulation formation and prognosis in patients with chronic complete coronary artery occlusion.Materials and MethodsFrom October 2017 to April 2019,126 patients with coronary heart disease with at least one major coronary artery CTO were selected for percutaneous coronary intervention(PCI)in the second affiliated Hospital of Zhengzhou University.The age of the patients ranged from 65.2 to 12.3 years old,including 72 males and 54 females.According to coronary angiography,patients with CTO were divided into two groups:poor collateral circulation group(72 cases)and good group(54 cases).According to the Cohen-Rentrop method,the patients were divided into two groups: poor collateral circulation group(n=72)and good group(n=54).Multivariate logistic regression analysis was used to further screen the factors affecting the formation of collateral circulation in patients with CTO.Using the receiver operating characteristic(ROC)curve,FAR was of good value in predicting the formation of collateral circulation in patients with CTO,and the prognosis was evaluated by the incidence of major adverse cardiovascular events(MACE)within one year of follow-up.Results1.There were significant differences in smoking proportion,age and history of diabetes between the two groups(P<0.05).There was no significant difference in hypertension history,sex ratio and blood lipid level between the two groups(P>0.05).The level of albumin in the good group was higher than that in the bad group,while the levels of FAR,fibrinogen,high sensitivity C-reactive protein,NT-proBnp,glycosylated hemoglobin and fasting blood glucose in the good group were lower than those in the bad group(P<0.01 or 0.05).The LVEF value of the good group was higher than that of the poor group(P<0.05).There was no significant difference in CTO occlusion of related arteries,interventional patency of related arteries and pre-hospital medication between the two groups(P>0.05).The incidence of major adverse cardiovascular events within 1 year of follow-up in the good group was lower than that in the poor group(P=0.011).2.Multivariate logistic analysis was performed with factors with statistically significant differences in univariate analysis,such as fibrinogen,albumin,FAR,high sensitivity C-reactive protein,age,NT-proBnp level,LVEF,glycosylated hemoglobin,fasting blood glucose,smoking history and diabetes history as independent variables.Multivariate Logistic analysis was performed according to the input method.Analysis showed that FAR,fibrinogen,high sensitivity C-reactive protein,fasting blood glucose and smoking were independently negatively correlated with good collateral circulation formation in CTO patients(P<0.01or0.05),while albumin level was positively correlated with good collateral circulation formation in CTO patients(P<0.01).3.The ROC curve showed that the area under the curve of admission FAR to predict good collateral circulation in CTO patients was 0.832(95%CI 0.755-0.893,P<0.001),the diagnostic threshold was 9.62,the sensitivity was 85.19%,and the specificity was 77.78%.While high sensitivity C-reactive protein(AUC=0.806,P <0.001),albumin(AUC=0.804,P<0.001),fibrinogen(AUC=0.788,P<0.001),fasting blood glucose(AUC=0.645,P=0.005),smoking(AUC=0.606,P=0.014).Conclusion1.The level of FAR on admission has a certain predictive value for the formation of collateral circulation in patients with chronic complete coronary artery occlusion.2.Patients with chronic complete occlusion of coronary artery with lower FAR level had better collateral circulation formation,lower incidence of major adverse cardiovascular events and good prognosis after the opening of CTO disease. |
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