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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Hyperinsulinemia Impaired Coronary Collateral Circulation in Patients with Chronic Total Coronary Occlusion
Xiaoyi Zou1, Ming Chen1, Limin Sun1
1Department of Cardiology, Qinhuangdao First Hospital, Hebei Medical University, Qinhuangdao, Hebei Province, People's Republic of China.
Insights
Hyperinsulinemia is linked to poor coronary collateral circulation in patients with chronic total coronary occlusion. This condition may predict reduced blood vessel formation, impacting cardiovascular health.
Area of Science:
- Cardiology
- Endocrinology
- Vascular Biology
Background:
- Hyperinsulinemia negatively affects cardiovascular and endothelial function.
- Chronic total coronary occlusion presents a challenge for myocardial perfusion.
- Coronary collateral circulation (CCC) is crucial for supplying blood to ischemic areas.
Purpose of the Study:
- To investigate the association between hyperinsulinemia and the development of CCC.
- To determine if hyperinsulinemia predicts poor collateralization in patients with chronic total coronary occlusion.
Main Methods:
- Patients with stable angina and chronic total coronary occlusion were classified into good (n=223) and poor (n=115) CCC groups based on Rentrop's classification.
- Fasting insulin (FINS), fasting glucose (FBS), and flow-mediated dilation (FMD) were measured.
- Logistic regression analysis identified predictors of poor CCC.
Main Results:
- The poor CCC group exhibited significantly higher FINS, FBS, HbA1c, and HOMA-IR levels.
- Poor CCC was associated with lower FMD, LVEF, and higher Syntax scores.
- Hyperinsulinemia (FINS ≥15.22 μIU/mL) was an independent predictor of poor CCC (OR 2.419).
Conclusions:
- Hyperinsulinemia is a significant predictor of inadequate coronary collateral formation in patients with chronic total coronary occlusion.
- Managing insulin resistance may be important for improving collateralization in these patients.
Background And Objectives:
Hyperinsulinemia impaired cardiovascular system and endothelial function in the population. The purpose of this study was to explore the relationship between hyperinsulinemia and coronary collateral circulation in patients with chronic total coronary occlusion.
Methods:
Patients with stable angina and at least one total coronary occlusion were enrolled in this study. Collateral grade was determined according to Rentrop's classification. Patients were divided into a good coronary collateral circulation (CCC) group (grade 2 or 3 collateral vessels, n = 223) and a poor CCC group (grade 0 or 1 collateral vessels, n = 115). Fasting insulin level (FINS) and fasting glucose level (FBS) were measured. Endothelial function evaluated by flow-mediated dilation (FMD).
Results:
Serum FINS level was significantly increased in the poor CCC group (P < 0.01). Patients in the poor CCC group had higher levels of FBS, HbA1C, and homeostasis model assessment for insulin resistance (HOMA-IR) than patients in the good CCC group. The poor CCC group also had lower levels of FMD, lower LVEF and higher syntax scores than the good CCC group. Hyperinsulinemia (T3, FINS ≥15.22 μIU/mL) increased OR for the incidence of the poor CCC group (OR 2.419, 95% CI 1.780-3.287) in multivariate analysis. Multivariate logistic regression also revealed that diabetes, HbA1c, HOMA-IR, HDL-C and Syntax score were independent predictors of poor CCC (all P < 0.05).
Conclusion:
Hyperinsulinemia is a valuable predictor of poor collateral formation in patients with chronic total coronary occlusion.
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