KRONİK TOTAL OKLÜZYONU OLAN HASTALARDA ÜRİK ASİT YÜKSEK YOĞUNLUKLU LİPOPROTEİN KOLESTEROL ORANI VE SERUM ÜRİK ASİT DÜZEYLERİNİN KORONER KOLLATERAL DOLAŞIM ÜZERİNDE KARŞILAŞTIRILMASI

Abstract

Amaç: Koroner kollateral dolaşım (KKD) kardiyovasküler prognoz üzerinde önemli bir rol oynar ve iyi gelişmiş KKD surviyi iyileştirir. Bu çalışmanın amacı, serum ürik asit ve yüksek yoğunluklu lipoprotein kolesterol oranının (ÜA/ HDL-K) koroner kollateral gelişimi ile ilişkili olup olmadığını araştırmaktır. Gereç ve Yöntem: Bu retrospektif çalışmaya stabil koroner arter hastalığı ve invaziv koroner anjiyografide en az bir kronik total oklüzyonu (KTO) olan 111 hasta dahil edildi. Anjiyografi işlemi öncesi tüm hastalardan kan örnekleri alındı. Kollateral derecesi Rentrop sınıflamasına göre belirlendi. Hastalar kötü KKD grubu (Rentrop derece 0-1, n=47) veya iyi KKD grubu (Rentrop derece 2-3, n=64) olarak sınıflandırıldı. ÜA/HDL-K oranları iki grup arasında karşılaştırıldı. Bulgular: ÜA/HDL-K oranları, kötü KKD’si olan hastalarda, iyi KKD’si olan hastalarla karşılaştırıldığında anlamlı olarak daha yüksekti (0,18 [0,06- 0,49] vs 0,14 [0,05-0,31], sırasıyla; p<0,001). Korelasyon analizinde, KKD, ÜA/HDL-K ve ÜA seviyeleri ile anlamlı bir negatif korelasyon gösterdi (r=- 0,333, p<0,001; r=-0,502, p<0,001, sırasıyla). ROC analizinde, ÜA/HDL-K oranı için > 0,17’lik bir kesme değeri, %54,3 duyarlılık ve %79,3 özgüllük ile zayıf kollateral gelişimini öngördü (AUC=0,711, 95% CI 0,617–0,794, p<0,001). Çok değişkenli regresyon analizinde, serum ÜA kötü kollateral gelişiminin bağımsız bir prediktörü olarak bulundu (OR=2,818, p=0,022). Sonuç: Bu çalışma göstermiştir ki, ÜA/HDL-K oranı zayıf kollateral gelişimi ile ilişkili olabilse de, serum ÜA seviyeleri, KTO’lu hastalarda ÜA/HDL-K oranlarından kötü KKD’nin daha iyi bir öngördürücüsü olarak görünmektedir.

Keywords

• Kronik total oklüzyon
• koroner kollateral dolaşım
• ürik asit
• yüksek yoğunluklu lipoprotein kolesterol

COMPARISON OF URIC ASID HIGH DENSITY LIPOPROTEIN CHOLESTEROL RATIO AND SERUM URIC ASID LEVELS ON CORONARY COLLETERAL CIRCULATION IN PATIENTS WITH CHRONIC TOTAL OCCLUSION

Abstract

Objective: Coronary collateral circulation (CCC) plays a significant role in cardiovascular prognosis, and well-developed CCC improves survival. The aim of this study was to investigate whether the serum uric acid to highdensity lipoprotein cholesterol ratio (UA/HDL-C) is associated with coronary collateral development. Materials and Methods: This retrospective study enrolled 111 patients with stable coronary artery disease and at least one chronic total occlusion (CTO) at invasive coronary angiography. Blood samples were obtained from all patients before the angiography procedure. The collateral degree was determined according to the Rentrop scoring system. Patients were classified into a poor CCC group (Rentrop grades 0-1, n=47) or a good CCC group (Rentrop grades 2-3, n=64). The UA/HDL-C ratios were compared between the two groups. Results: The UA/HDL-C ratios were significantly higher in patients with poor CCC compared with the patients with good CCC (0.18 [0.06-0.49] vs 0.14 [0.05-0.31], respectively; p<0.001). In correlation analysis, the CCC was significantly negatively correlated with UA/HDL-C and UA levels (r=- 0.333, p<0.001; r=-0.502, p<0.001, respectively). According to the ROC analysis, a cut-off value of > 0.17 for the UA/HDL-C ratio predicted poor collateral development with 54.3% sensitivity and 79.3% specificity (AUC=0.711, 95% CI 0.617–0.794, p<0.001). In multivariate regression analysis, serum UA was found to be an independent predictor of poor collateral development (OR=2.818, p=0.022). Conclusion: The present study showed that although the UA/HDL-C ratio may be associated with poor collateral development, serum UA levels seem to be a better predictor of poor CCC than UA/HDL-C ratios in patients with CTO.

Keywords

• Chronic total occlusion
• coronary collateral circulation
• uric acid
• high-density lipoprotein cholesterol

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