Silent Predictors of Chronic Total Occlusion in Patients with Stable Angina Pectoris: The Role of Inflammatory and Metabolic Biomarkers

Öz

Introduction: Atherosclerosis and inflammation play central roles in the pathogenesis of coronary artery disease (CAD). Early identification of chronic total occlusion (CTO) in patients presenting with stable angina pectoris is clinically important for guiding treatment strategies. Therefore, evaluating the diagnostic utility of novel inflammatory and metabolic biomarkers has gained increasing relevance. This study aimed to assess the predictive value of the systemic inflammatory index (SII), uric acid/HDL ratio (UHR), monocyte/HDL ratio (MHR), and triglyceride–glucose (TyG) index for detecting the presence of CTO. Materials and Methods: In this retrospective study, 96 patients who underwent coronary angiography between January 1, 2024 and April 1, 2025 at Mersin City Training and Research Hospital were included. Thirty-six patients with at least one coronary artery showing 100% occlusion constituted the CTO group, while 60 patients without CTO formed the control group. Demographic characteristics and laboratory parameters were recorded, and SII, UHR, MHR, and TyG values were calculated and compared between groups. Results: There were no significant differences between the groups regarding SII (p = 0.118), UHR (p = 0.887), or TyG (p = 0.333). However, MHR levels were significantly higher in the CTO group (p < 0.001). ROC analysis identified an MHR cutoff value of > 8.7 as a meaningful threshold for predicting CTO. Discussion: Among the biomarkers evaluated, only MHR demonstrated a significant association with the presence of CTO. Reflecting increased monocyte activity and reduced anti-inflammatory HDL capacity, MHR appears consistent with the chronic inflammatory nature of CTO. Its simplicity, low cost, and availability from routine laboratory tests further support MHR as a practical biomarker for assessing CTO risk in clinical practice.

Anahtar Kelimeler

• Atherosclerosis
• stable angina
• coronary artery disease
• chronic total occlusion
• inflammation
• monocyte/HDL ratio
• biomarkers

Destekleyen Kurum

This research did not receive funding from any specific agency in the public, commercial, or nonprofit sectors.

Etik Beyan

The study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Mersin City Training and Research Hospital and Mersin University Clinical Research Ethics Committee (Date: 28.05.2025, Decision No: 2025/614).

Teşekkür

We thank Prof. Dr. Gülhan Temel for her valuable assistance with the statistical analysis. We also extend our gratitude to Barış Düzel for his support in the retrospective identification of CTO patients and for facilitating access to angiographic imaging records.

Stabil Angina Pektorisli Hastalarda Kronik Total Oklüzyonun Sessiz Habercileri: İnflamatuar ve Metabolik Belirteçlerin Rolü

Öz

Giriş: Ateroskleroz ve inflamasyon, koroner arter hastalığının (KAH) temel mekanizmalarını oluşturmaktadır. Stabil angina pektoris ile başvuran hastalarda kronik total oklüzyonun (KTO) erken öngörülmesi klinik karar verme süreçlerini doğrudan etkiler. Bu nedenle yeni inflamatuvar ve metabolik belirteçlerin tanısal değerinin araştırılması önem taşımaktadır. Bu çalışma, sistemik inflamatuar indeks (SII), ürik asit/HDL oranı (UHO), monosit/HDL oranı (MHO) ve trigliserid–glukoz indeksi (TyG) gibi biyobelirteçlerin KTO öngörüsündeki yerini değerlendirmeyi amaçlamıştır. Gereç ve Yöntemler: Bu retrospektif çalışmada, 1 Ocak 2024–1 Nisan 2025 tarihleri arasında Mersin Şehir Eğitim ve Araştırma Hastanesi’nde koroner anjiyografi yapılan 96 hasta incelendi. En az bir koroner arterde %100 oklüzyon saptanan 36 hasta KTO grubunu, KTO bulunmayan 60 hasta ise kontrol grubunu oluşturdu. Demografik ve laboratuvar verileri kaydedildi; SII, UHO, MHO ve TyG indeksleri hesaplanarak gruplar arasında karşılaştırıldı. Sonuç: KTO ve kontrol grupları arasında SII (p = 0.118), UHO (p = 0.887) ve TyG (p = 0.333) açısından anlamlı fark saptanmadı. Buna karşılık MHO seviyeleri KTO grubunda belirgin şekilde daha yüksekti (p < 0.001). ROC analizine göre MHO > 8.7, KTO varlığını öngörmede anlamlı bir eşik değer olarak belirlendi. Tartışma: Çalışma bulguları, incelenen belirteçler arasında yalnızca MHO’nun KTO varlığını anlamlı biçimde öngördüğünü göstermiştir. Monosit aktivasyonundaki artış ile HDL’nin antiinflamatuvar etkisinin azalmasını birlikte yansıtan MHO, KTO’nun kronik inflamatuvar yapısıyla uyumlu bir biyobelirteç olarak değerlendirilebilir. Rutin testlerden kolayca hesaplanabilmesi, MHO’yu klinik pratikte KTO riskinin belirlenmesinde kullanılabilir bir parametre hâline getirmektedir.

Anahtar Kelimeler

• Ateroskleroz
• stabil angina
• koroner arter hastalığı
• kronik total oklüzyon
• inflamasyon
• monosit/HDL oranı
• biyobelirteçler

Destekleyen Kurum

Bu araştırma, kamu, ticari veya kar amacı gütmeyen sektörlerdeki herhangi bir özel kuruluş tarafından finanse edilmemiştir.

Etik Beyan

Çalışma, Helsinki Bildirgesi’nin ilkelerine uygun olarak yürütülmüş ve Mersin Şehir Eğitim ve Araştırma Hastanesi ile Mersin Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Tarih: 28.05.2025, Karar No: 2025/614).

Teşekkür

İstatistiksel analiz konusundaki değerli katkılarından dolayı Prof. Dr. Gülhan Temel’e teşekkür ederiz. Ayrıca, KTO hastalarının retrospektif olarak belirlenmesindeki desteği ve anjiyografik görüntü kayıtlarına erişimi kolaylaştırdığı için Barış Düzel’e de teşekkürlerimizi sunarız.

Kaynakça

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