Endothelial Activation and Stress Index Predicts Poor Coronary Collateral Development in Chronic Total Occlusion

Area of Science:

• Cardiology
• Vascular Biology
• Biomarkers

Background:

• Coronary collateral circulation (CCC) is crucial for mitigating ischemic damage in chronic total occlusion (CTO).
• Individual variability in CCC development is significant, influenced by endothelial stress and inflammation.
• The Endothelial Activation and Stress Index (EASIX) reflects endothelial dysfunction and inflammation but its role in CTO-related CCC is understudied.

Purpose of the Study:

• To investigate the association between the EASIX score and the grade of coronary collateral circulation (CCC) in patients with CTO.
• To determine if EASIX can serve as a predictive marker for impaired collateral vessel development in CTO.

Main Methods:

• Retrospective analysis of 186 CTO patients undergoing coronary angiography.
• CCC assessed using the Rentrop-Cohen classification (poorly vs. well-developed).
• EASIX calculated from lactate dehydrogenase, creatinine, and platelet count; logistic regression and ROC analysis performed.

Main Results:

• Poorly developed CCC was present in 37.6% of patients.
• Higher EASIX values were significantly associated with poorly developed CCC (p < 0.001).
• Standardized EASIX independently predicted poorly developed CCC (OR 2.536 per SD increase), with moderate discrimination (AUC 0.718).

Conclusions:

• Elevated EASIX is independently associated with impaired coronary collateral circulation in CTO patients.
• EASIX may represent a simple, cost-effective biomarker for assessing endothelial stress and risk stratification in CTO.
• Further prospective research is needed to confirm findings and clinical utility.