Increased estimated remnant-like particle cholesterol is associated with impaired coronary collateralization in patients with coronary chronic total occlusions

Ang Gao; Jinxing Liu; Yan Liu; Chengping Hu; Yong Zhu; Yujie Zhou; Hongya Han; Yingxin Zhao

doi:10.1186/s13098-022-00829-6

Increased estimated remnant-like particle cholesterol is associated with impaired coronary collateralization in patients with coronary chronic total occlusions

Diabetol Metab Syndr. 2022 Apr 21;14(1):57. doi: 10.1186/s13098-022-00829-6.

Authors

Ang Gao¹, Jinxing Liu², Yan Liu¹, Chengping Hu¹, Yong Zhu¹, Yujie Zhou¹, Hongya Han³, Yingxin Zhao⁴

Affiliations

¹ Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China.
² Department of Cardiology, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China. hhy123100@163.com.
⁴ Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, 100029, China. zyingxinmi@163.com.

Abstract

Aims: This study intends to explore whether, or to what extent, the estimated remnant-like particle cholesterol was associated with coronary collateralization in patients with chronic total occlusion lesions.

Methods: 792 patients with at least one coronary chronic total occlusion lesion were enrolled. Serum level of lipid profiles were determined and the estimated remnant-like particle cholesterol was calculated. The development of coronary collateralization was graded as low (Rentrop score 0-1) or high (Rentrop score 2-3) collateralization according to the Rentrop classification system and then the association between the estimated remnant-like particle cholesterol and collateralization was assessed.

Results: 222 participants were classified into low collateralization group. The estimated remnant-like particle cholesterol level was significantly higher in low collateralization (P < 0.001) and type 2 diabetes mellitus (P = 0.009) group. To further explore the association between the estimated remnant-like particle cholesterol and the development of coronary collateralization, these patients were divided into 3 groups based on the estimated remnant-like particle cholesterol tertiles. The prevalence of low collateralization increased stepwise with the tertile groups (T1 12.5% vs. 27.1% vs. 45.3%, P < 0.001). Multivariate logistic regression analysis showed that the estimated remnant-like particle cholesterol was independently associated with the under-developed collateralization, with an OR and 95%CI of 2.34 (1.46-3.74) and 4.91 (3.01-8.02) in the T2 and T3 group, respectively. The following receiver-operating characteristic analysis indicated that the diagnostic value of estimated remnant-like particle cholesterol for the low collateralization was 0.696, with a cut-off value of 0.485, and its sensitivity was 82.88%. Besides, the addition of the estimated remnant-like particle cholesterol into the baseline model consisting of traditional risk factors could improve the incremental value of the discrimination of impaired collateralization only in overall and type 2 diabetes mellitus populations.

Conclusions: The increased estimated remnant-like particle cholesterol is independently associated with impaired collateralization in patients with coronary chronic total occlusion lesions. Therapies targeting at remnant-like particle cholesterol may be needed in advanced coronary artery disease patients with type 2 diabetes mellitus not suitable for vascular revascularization.

Keywords: Coronary artery disease; Coronary chronic total occlusion; Coronary collateralization; Remnant-like particle cholesterol; Type 2 diabetes mellitus.