| Objective: Coronary chronic total occlusion(CTO)is a severe vascular stenosis in the terminal stage of atherosclerotic lesions.CTO is characterized by high incidence,difficult early identification,complex lesion structure,difficult interventional operation,low recurrence rate,high mortality,poor prognosis,etc.Early recognition and prognosis assessment are particularly important.Numerous studies have shown that Hypersensitive C-reactive protein(Hs-CRP),as a representative inflammatory cytokine,It can damage Vascular endothelial cells(VECs),stimulate the proliferation of Vascular smooth muscle cells(VSMCs),and promote monocyte adhesion to VECs.oxidized low-density lipoprotein(ox-LDL)uptake and other mechanisms promoted the development of AS.Is a marker of cardiovascular disease risk and prognosis.Therefore,this study intends to explore the correlation between Hs-CRP and CTO,as well as the predictive value of Hs-CRP for the prognosis of patients with CTO.Methods: A total of 826 patients who underwent coronary angiography due to chest pain or abnormal electrocardiogram in the Department of Cardiovascular Sciences of Western Theater Command General Hospital from January 2020 to June 2021 were retrieved.The patients with important clinical data missing,clear history of coronary heart disease,acute coronary syndrome,co-infection and traumatic stress were excluded.According to the results of coronary angiography,the patients were divided into normal coronary group,partial coronary stenosis group and coronary occlusion group.Baseline and coronary angiography data of all enrolled patients were collected.Firstly,data differences were analyzed by univariate analysis of variance or nonparametric test or chi-square test.Pearson correlation analysis was used to investigate the relationship between CTO and relevant data.The ROC curve was used to test the predictive efficacy of Hs-CRP on CTO.Secondly,the coronary artery occlusion group was divided into good collateral circulation group and poor collateral circulation group according to Rentrop grade.Independent sample t test or Mann-Whitney U test or chi-square test were used to analyze the data difference between the two groups,and binary logistic regression was used to analyze the independent risk factors for the formation of coronary collateral circulation of CTO.Finally,the occurrence of endpoint events in the CTO group in the past 1 year was traced,and survival analysis was used to determine the predictive value of serum Hs-CRP level for the prognosis of CTO patients.Results: A total of 324 patients meeting the criteria were enrolled in this study,including 100 patients in the normal coronary artery group,130 patients in the partial coronary stenosis group,and 94 patients in the coronary artery occlusion group.(1)General clinical data showed;There were statistically significant differences in age,sex,Hb A1 c,FBG,Hs-CRP,HDL-C,SUA,smoking history,diabetes history,hypertension and hyperlipidemia among different stenosis groups(P<0.05).With the increase of age,the incidence and severity of coronary artery disease also increased gradually.Men are more likely to develop coronary artery disease than women.Hb A1 c,fasting blood glucose,Hs-CRP and SUA in CTO group were higher than those in coronary artery stenosis group,and the differences were statistically significant(all P<0.05).The prevalence of diabetes,hypertension,hyperlipidemia and smoking history in CTO group was higher than that in coronary artery stenosis group,and the differences were statistically significant(all P <0.05).The high density lipoprotein cholesterol(HDL-C)in CTO group was lower than that in coronary artery stenosis group than that in normal group,and the difference was statistically significant(P<0.05).There were no significant differences in BMI,total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)among the three groups(all P >0.05).The effects of age,sex,Hb A1 c,FBG,hs-CRP,HDL-C,SUA,smoking history,diabetes history,hypertension history and hyperlipidemia on the formation of CTO were analyzed by ordered logistic regression conforming to the hypothesis of proportional dominance.The results showed that age(OR = 1.05,95%CI: 1.02 ～ 1.07,P < 0.001),hs-CRP(OR =2.24,95%CI: 1.81 ～ 2.77,P < 0.001),SUA(OR = 1.00,95%CI: 1.00 ～ 1.01,P= 0.02),smoking(OR = 0.45,95%CI: 0.23-0.87,P = 0.02),hyperlipidemia(OR= 0.18,95%CI: 0.10-0.34,P < 0.001)were independent risk factors for CTO.HDL-C(OR = 0.18,95%CI: 0.07-0.48,P = 0.001)was an independent protective factor for CTO.Patients were divided into CTO group and non-CTO group(normal group + coronary heart disease group).ROC curve showed that when hs-CRP cut-off value was 2.55mg/L,the sensitivity to predict CTO was0.596,the specificity was 0.839,and the area under the curve was 0.797(95%CI: 0.75 ～ 0.85,P < 0.001).When the HDL-C mmol/L cut-off value was1.03mg/L,the sensitivity,specificity,and area under the curve were 0.585,0.213,and 0.372(95%CI: 0.30-0.44,P < 0.001).When the SUA ummol/L cut-off value was 417mg/L,the sensitivity,specificity and area under the curve were 0.489,0.796 and 0.658(95%CI: 0.59 ～ 0.73,P < 0.001).When the cut-off age was 68.5 years,the sensitivity,specificity,and area under the curve were0.468,0.70,and 0.592(95%CI: 0.53-0.66,P=0.009).When the FBG mmol/L cut-off value was 5.355,the sensitivity,specificity,and area under the curve were 0.745,0.513,and 0.637(95%CI: 0.57 ～ 0.70,P < 0.001).(2);There were statistical significance in Hs-CRP,SUA,cystatin and recurrence rates between good and poor collateral circulation groups(all P < 0.05).Hs-CRP,SUA,cystatin and recurrence rates in good group were higher than those in bad group.Binary logistic regression analysis showed that hs-CRP(OR = 2.84,95%CI:1.45-5.57,P=0.002),SUA(OR = 1.05,95%CI: 1.02 ～ 1.07,< 0.001)was an independent risk factor for poor collateral circulation.There were no significant differences in age,gender,BMI,LDL-C,HDL-C,TC,Hb A1 c,FBG,TNT,CK-MB,fibrinogen,smoking history,hypertension history,diabetes history and hyperlipidemia history between 2 groups(all P > 0.05).ROC curve analysis showed that when the cut-off value of hs-CRP was 2.67mg/L,the sensitivity and specificity of CTO prediction were 0.851,0.766 and 0.847(95%CI:1.45-5.57,P=0.002).When SUA ummol/L cut-off value was 406mg/L,the sensitivity,specificity and area under the curve were 0.915,0.872 and 0.945(95%CI: 1.02-1.07,P < 0.001).(3);The median Hs-CRP(2.935mg/L)was used as the dividing point,and the patients with CTO were divided into the low level group and the high level group to compare the difference in end events between the two groups.The results showed that the incidence of MACE events in the high level group was much higher than that in the low level group within 1 year,and the difference was statistically significant(P < 0.001).Conclusion: 1.Serum hs-CRP level in CTO patients is significantly higher than that in non-CTO patients,and the increase of serum hs-CRP level can independently predict CTO.2.Serum hs-CRP level in patients with good collateral circulation is significantly lower than that in patients with poor collateral circulation,which can independently predict the establishment of collateral circulation of CTO3.hs-CRP level is correlated with the prognosis of CTO patients,and CTO patients with high Hs-CRP have a higher incidence of MACE within 1 year. |
