Coronary collateral circulation in patients with chronic coronary total occlusion; its relationship with cardiac risk markers and SYNTAX score.

BACKGROUND: Compared to patients without a collateral supply, long-term cardiac mortality is reduced in patients with well-developed coronary collateral circulation (CCC). Cardiovascular risk markers, such as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP) and high-sensitive cardiac troponin T (hs-cTnT) are independent predictors for cardiovascular mortality. OBJECTIVES: The main goal of this study was to examine the relationship between CCC and cardiovascular risk markers. METHODS: We prospectively enrolled 427 stable coronary artery disease patients with chronic total occlusion (mean age: 57.5±11.1 years). The patients were divided into two groups, according to their Rentrop scores: (a) poorly developed CCC group (Rentrop 0 and 1) and (b) well-developed CCC group (Rentrop 2 and 3). NT-proBNP, hs-CRP, hs-cTnT, uric acid and other biochemical markers were also measured. The SYNTAX score was calculated for all patients. RESULTS: The patients in the poorly developed CCC group had higher frequencies of diabetes and hypertension (p<0.05 for both). Compared to the well-developed CCC group, the SYNTAX score, Hs-cTnT, hs-CRP, NT-proBNP, uric acid, neutrophil count and mean platelet volume (MPV) values were higher in patients with poorly developed CCC (p<0.05 for all). On multivariate logistic regression analysis, hs-cTnT (ß=0.658, 95% CI=0.589-0.735, p<0.001) and NT-proBNP (ß=0.991, 95% CI=0.987-0.995, p<0.001) as well as hs-CRP and diabetes were independent predictors of CCC. CONCLUSION: Cardiac risk markers, such as NT-proBNP, hs-cTnT and hs-CRP are independently associated with CCC in stable coronary artery disease with chronic total occlusion.

NT-proBNP is associated with SYNTAX score and aortic distensibility in patients with stable CAD.

OBJECTIVE: A high N-terminal pro-brain natriuretic peptide (NT-proBNP) level provides significant prognostic information on patients with coronary artery disease (CAD). It is unclear whether aortic distensibility (AD), which reflects the aortic stiffness, and the extent and complexity of CAD, assessed with the SYNTAX score (SS), affect the secretion of NT-proBNP in stable CAD. We aimed to investigate the relationship between NT-proBNP levels and AD as well as with the extent and complexity of CAD in stable CAD patients. METHODS: The study included 411 patients with stable CAD (mean age = 61.7 ± 9.9 years, male/female = 247/164). The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group < 114 pg/ml and NT-proBNPhigh group ≥ 114 pg/ml). AD was calculated from the echocardiographically derived ascending aorta diameters and hemodynamic pressure measurements. Coronary angiography was performed and SS was determined in all patients. NT-proBNP and other biochemical markers were measured in all subjects. RESULTS: The AD and ejection fraction values of the NT-proBNPhigh group were lower and their SS levels were higher compared with those from the NT-proBNPlow group (p < 0.05, for all). The NT-proBNP level was independently associated with AD (ß = -0.378, p < 0.001), SS (ß = 0.262, p < 0.001), and ejection fraction (ß = - 0.295, p < 0.001) on multiple linear regression analysis. CONCLUSION: NT-proBNP was independently associated with an impaired elastic property of the aorta and with the extent and complexity of CAD as well as with left ventricular systolic dysfunction.