Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion

Esenboga, Kerim; Kurtul, Alparslan; Yamanturk, Yakup Yunus; Kozluca, Volkan; Tutar, Eralp

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Original Article • Arq. Bras. Cardiol. 121 (2) • 2024 • https://doi.org/10.36660/abc.20230765 copy

Prognostic Nutritional Index is Associated with the Degree of Coronary Collateral Circulation in Stable Angina Patients with Chronic Total Occlusion

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Coronary collateral circulation (CCC) can effectively improve myocardial blood supply to the area of CTO (chronic total coronary occlusion) and can, thus, improve the prognosis of patients with stable coronary syndrome (SCS). The degree of inflammation and some inflammation markers were associated with the development of collaterals.

Objective:

To investigate whether prognostic nutritional index (PNI) has an association with the development of CCC in patients with SCS.

Methods:

A total of 400 SCS patients with the presence of CTO in at least one major epicardial coronary artery were included in this study. The patients were divided into two groups according to the Rentrop score. Scores of 0 to 1 were considered poor developed CCC, and scores of 2 to 3 were accepted as good developed CCC. Statistical significance was set as a p-value < 0.05 for all analyses.

Results:

The mean age of the study cohort was 63±10 years; 273 (68.3%) were males. The poor-developed CCC group had a significantly lower PNI level compared with the good-developed CCC group (38.29±5.58 vs 41.23±3.85, p< 0.001). In the multivariate analysis, the PNI (odds ratio 0.870; 95% confidence interval 0.822-0.922; p< 0.001) was an independent predictor of poorly developed CCC.

Conclusion:

The PNI can be used as one of the independent predictors of CCC formation. It was positively associated with the development of coronary collaterals in SCS patients with CTO.

Keywords:
Collateral Circulation; Nutrition Assessment; Inflammation

Characteristics		Good collateral group (n=270)	Poor collateral group (n=130)	p value
Age		62.28±9.87	64.68±11.46	0.032
Female gender		72 (26.7%)	55 (42.3%)	0.002
History of arterial hypertension (n, %)		170 (63%)	70 (53.8%)	0.081
History of diabetes mellitus (n, %)		84 (31.1%)	43 (33.1%)	0.692
Active smoking (n, %)		110 (40.7%)	36 (27.7%)	0.011
History of hyperlipidemia (n, %)		142 (52.6%)	54 (41.5%)	0.038
Family history of coronary heart disease (n, %)		73 (27%)	34 (26.2%)	0.852
Multivessel coronary artery disease		130 (48.1%)	54 (41.5%)	0.214
Chronic total occlusion vessel
	Left anterior descending	64 (23.7%)	43 (33.1%)
	Circumflex artery	45 (16.7%)	30 (23.1%)	0.012
	Right coronary artery	161 (59.6%)	57 (43.8%)
Prior beta-blocker therapy (n, %)		148 (54.8%)	71 (54.6%)	0.970
Prior angiotensin-converting enzyme inhibitors therapy (n, %)		166 (61.5%)	69 (53.1%)	0.110
Prior clopidogrel therapy (n, %)		92 (34.1%)	31 (23.8%)	0.138
Prior statin therapy (n, %)		166 (61.5%)	75 (57.7%)	0.468
Systolic blood pressure (mmHg)		126.7±15.9	125.9±15.6	0.610
Diastolic blood pressure (mmHg)		87.13±11.56	78.52±10.25	0.231
Left ventricular ejection fraction (%)		47.72±11.34	46.43±12.37	0.302
Number of chronic total occlusion vessel
	1	167 (61.9%)	86 (66.2%)
	2	53 (19.6%)	30 (23.1%)	0.132
	3	50 (18.5%)	14 (10.8%)

Variables	Good collateral group (n=270)	Poor collateral group (n=130)	p value
Prognostic nutrional index	41.23±3.85	38.29±5.58	<0.001
Serum creatinine (mg/dl)	0.97±0.27	0.99±0.25	0.692
Glomerular filtration rate (mL/min/1.73 m²)	86.09±16.43	82.54±17.9	0.158
Lymphocyte count (×10⁹/L)	2.71±0.89	2.55±0.94	0.112
White blood cell count (×10⁹/L)	8.07±2.06	8±2.35	0.747
Platelet count (×10⁹/L)	254.06±83.7	250.55±65.09	0.646
Hemoglobin (g/dL)	14.69±8.34	13.58±2	0.133
Serum glucose (mg/dl)	124.81±63.96	132.28±80.24	0.354
Total cholesterol (mg/dl)	191.45±55.72	178.98±47.19	0.028
Low-density lipoprotein cholesterol (mg/dl)	115.56±39.09	104.49±38.44	0.008
High-density lipoprotein cholesterol (mg/dl)	41.16±22.63	43.52±27.24	0.392
Triglyceride (mg/dl)	154 (110-219)	144 (101-190)	0.186
High-sensitivity C-reactive protein (mg/dl)	3.67 (2.12-6.98)	4.69 (2.32-12.8)	0.028
Albumin (g/dL)	4.12±0.38	3.87±0.54	<0.001

Variable	Odds ratio	95% Confidence interval	p value
Prognostic nutrional index	0.870	(0.822-0.922)	<0.001
Age	0.994	(0.970-1.018)	0.617
Female gender	1.845	(1.056-3.223)	0.031
Hypertension	1.574	(0.931-2.658)	0.098
Active smoking	1.398	(0.786-2.487)	0.255
Total cholesterol	1.002	(0.994-1.010)	0.694
Low-density lipoprotein cholesterol	0.991	(0.979-1.002)	0.098
High-sensitivity C-reactive protein	1.019	(1.000-1.038)	0.051
Hyperlipidemia	1.154	(0.702-1.897)	0.572

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[1] Mailing Address: Kerim Esenboga • Ankara University Faculty of Medicine – Cardiology – Iran Street E block Apartment No. 8 Çankaya/Ankara 06100 – Turkey. E-mail: kerimesenboga@yahoo.com