| Background and ObjectiveChronic total occlusion(CTO) refers to the coronary artery, on the basis of atherosclerotic lesions, due to thrombosis and repeated organization, which result in completely blocked to coronary artery vascular cavity, and occlusive disease for more than 3 months. It is reported that about 20%-40% of patients with significant coronary artery disease had chronic total occlusion. Owing to pathology and special anatomical characteristics of CTO, compared with non-CTO lesions, it has lower operation success rate and higher incidence of complications, which are called“the last piece of ground”of coronary interventional treatment.Coronary collateral circulation(CCC) is a congenital heart vessel which has a diameter of 20 μm~350 μm potential flow channel, usually in a unopen state, when the coronary artery become to significant stenosis or occlusion,they come to be open, hyperplasia, and gradually developed into a functional significance of CCC. Good collateral circulation provides a compensatory blood supply to an ischemic region in coronary artery disease, which is conducive to have a protection of myocardial stunning and hibernation, improve left ventricular function, inhibit left ventricular aneurysm formation and even increase the survival rate. Recently a meta-analysis by Meier showed that patients with a high degree of collateralization have a 36% lower risk of mortality than those with a low degree of collateralization.High sensitivity C reactive protein(hs-CRP), as an inflammatory marker, has unique stability and smaller difference of the diurnal variation, which is convenient to detect and can predict cardiovascular events to the healthy population and patients to some extent. Research shows there is a close connection between hs-CRP levels and the severity of coronary heart diseases, and the baseline level of hs-CRP have received more and more attentions as an independent risk factor of cardiovascular disease. But at present the research on hs-CRP and the patients with coronary collateral circulation of CTO are paid less attentions. The purpose of study on the classification of coronary collateral circulation in patients with CTO, is to explore the relationship between the level of hs-CRP in patients with CTO and the formation of coronary collateral circulation. MethodsA total of 138 patients with chronic total occlusion(at least one major coronary total occlusion) were included in this study. Coronary collateral circulation was graded according to the Rentrop scoring system. There were in 66 patients with Rentrop 0 and 1(poor CCC) and 72 patients with Rentrop 2 and 3(good CCC), serum concentrations of hs-CRP were measured by immune Turbidimetry.SPSS for Windows 17.0, a statistical packet program, was used for statistical analysis. Continuous variables are presented as mean±standard deviation(SD) and categorical data aresummarized as frequencies or percentages. Differences between groups were assessed by unpaired Student t test. Groups are compared using Pearson x2 test. Spearman correlation coefficient was used for correlation analysis.Logistic regression was used for multivariate analysis. Receiver operating characteristic(ROC) curve was plotted to assess the power of hs-CRP for detecting collateralization; Statistical significance was defined as p < 0.05. Result1. The poor coronary collateral group had significantly higher levels of serum hs-CRP compared to the good collateral group(5.58±3.14mg/dl VS 3.29±2.08mg/dl,P<0.001).2. Multiple logistic regression analysis showed that hs-CRP levels were independent predictors of poor collateral circulation(OR=1.326,95% CI=1.052~ 1.308, P=0.004).3. The result of ROC curve analysis for hs-CRP was as following: area under the ROC curve(AUC=0.708,P<0.001), with 72.23% sensitivity and 65.28% specificity. ConclusionHigher hs-CRP levels are associated with poor coronary collateral circulation and may be a significant predictor of poor CC development in patients with CTO. |
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