Predictive Factors Analysis Of Rentrop Classification In Coronary Artery Circulation

Part one The relationship between C-reactive protein and coronary collateral circulationBackground:Coronary collateral circulation(CCC)is a mechanism that compensates for obstructive coronary artery disease.Exploring CCC's potential influencing factors has been a long-term interest to cardiologists.In this study,the association between serum C-reactive protein(CRP)levels and CCC was investigated in Chinese patients with angiography-proven 95%coronary stenosis.Methods:There were 1,158 patients enrolled in this study who had undergone coronary angiography and showed 95%occlusion in at least one major epicardial coronary artery.Patients were classified into two groups:poor CCC(Rentrop grades 0-1)and good CCC(Rentrop grades 2-3).CRP levels were grouped using the following two types of models:Mode 1 discretized CRP group with 33 and 66%as the critical values and Mode 2 discretized CRP group with 1.0 and 3.0 mg/L as the cut off values.The association of serum CRP levels with CCC was assessed.Results:There were significant differences in serum CRP levels between the two groups(5.76 ± 3.45 vs.3.49 ± 2.44 mg/L,respectively;p<0.001),and compared with the first CRP tertile,the risks of poor CCC were higher in the second and third CRP tertiles(OR 2.31,95%CI[1.67,3.19],OR 6.25,95%CI[4.52,8.62],respectively).In the receiver operating characteristic curve analysis,the optimal cutoff value of CRP to predict poor CCC was 4.21 mg/L with 59.6%sensitivity and 74.33%specificity.Conclusion:Serum CRP levels is an independent predictor for poor CCC and might supply a useful biomarker in clinical applications.Part two The relationship between endothelin-1(ET-1)and coronary collateral circulationBackground:Coronary collateral circulation(CCC)plays an important role in protecting the heart from ischemic damage.Thus,studies on potential influencing factors are of clinical interest,particularly in patients with severe coronary stenosis.In this study,we investigated the association of plasma endothelin-1(ET-1)levels with CCC in patients with angiography-proven 95%coronary stenosis.Methods:We enrolled 1038 patients who had undergone coronary angiography and had 95%occlusion in at least one major epicardial coronary artery.Patients were classified into the poor or good CCC group(Rentrop grades 0-2 and 3,respectively).The association of plasma ET-1 levels with CCC was assessed.Results:Plasma ET-1 levels differed significantly between the two groups(0.56±0.44pmol/L vs.0.33±0.37pmol/L,p<0.001).ET-1 values decreased with increasing Rentrop grade(0,1,2,and 3),with mean ET-1 values of 0.79±0.67pmol/L,0.63±0.48pmol/L,0.42±0.47pmol/L,and 0.33±0.36pmol/L,respectively.Moreover,higher plasma ET-1 levels were an independent predictor for poor CCC(odds ratio 3.10,p<0.001).The receiver operator characteristic curve analysis indicated that the optimal ET-1 cut-off value to predict poor CCC was 0.30pmol/L with 60%sensitivity and 63.42%specificity.Conclusions:Our data firstly indicated that plasma ET-1 might be a useful,easily available predictor for CCC degree in patients with severe coronary artery disease.Part three The relationship between Lipoprotein(a)(Lp(a))and coronary collateral circulationBackground:As a mechanism compensating for obstructive coronary artery ailment,coronary collateral circulation(CCC)has attracted extensive cardiologists for a long time to explore its possible impact factors.In the paper,Chinese patients were suffered from 95%coronary stenosis,as diagnosed by angiography,to study the relationship between CCC and Lipoprotein(a)(Lp(a))levels.Methods:A total of 654 subjects were suffered from 95%occlusion of at least one major coronary occlusion,as diagnosed by angiography,which were divided into four categories:Rentrop grade 0,1,2,3.The models below had been applied to divide Lp(a)levels:in Mode 1,Lp(a)group was discretized,whose critical value was 33 and 66%;and in Mode 2,it was discretized and its cut off value was 30.0 mg/dl.Furthermore,we evaluated the relationship between CCC and serum Lp(a)levels.Results:The four groups had significantly different Lp(a)levels(25.80±24.72,18.99±17.83,15.39±15.80,and 8.40±17.75mg/dl respectively;p<0.001).In mode 1,concerning R0,its risk in the third Lp(a)tertile(OR 3.34,95%CI[2.32,4.83])was greater than that in the first Lp(a)tertile.In mode 2,concerning R0,its risk in Lp(a)>30.0 group(OR 6.77,95%CI[4.44,10.4])was greater than of Lp(a)<30.0mg/dl.Conclusions:The worse condition of CCC can be predicted independently by Lp(a)levels.In clinical,besides,Lp(a)levels can also be used biologically for marking.