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The HALP Score and Its Association With Coronary Collateral Circulation Development in Chronic Total Occlusion

Cuma Süleymanoğlu1, Fuat Polat2, Emre Paçacı1

  • 1Department of Cardiology, Osmaniye Training and Research Hospital, Osmaniye, Turkey.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|April 6, 2026
PubMed

Insights

The HALP score, integrating hemoglobin, albumin, lymphocyte, and platelet levels, is strongly linked to better coronary collateral circulation in chronic total occlusion patients. This simple score may aid in assessing collateral development and patient risk.

Area of Science:

  • Cardiology
  • Biomarkers
  • Vascular Biology

Background:

  • Coronary collateral circulation is vital for patients with chronic total occlusion (CTO), offering compensatory blood flow.
  • The HALP score (hemoglobin, albumin, lymphocyte, platelet) reflects systemic inflammation and nutritional status.
  • The association between the HALP score and collateral development in CTO patients was previously unknown.

Purpose of the Study:

  • To investigate the relationship between the HALP score and coronary collateral circulation quality in CTO patients.
  • To assess collateral circulation using the established Werner classification.

Main Methods:

  • A retrospective study of 240 CTO patients undergoing coronary angiography.
  • Calculation of the HALP score using a specific formula.
  • Grading of collateral circulation via Werner classification (CC0-CC3), with good collateral defined as CC score ≥2.

Main Results:

  • A significant positive correlation (r=0.807) was found between the HALP score and the Werner grade.
  • HALP scores progressively increased with better collateral grades (CC0 to CC3).
  • The HALP score was independently associated with good collateral circulation (OR: 3.762), with an optimal cutoff of 3.509 (AUC: 0.885).

Conclusions:

  • The HALP score is significantly associated with coronary collateral circulation development in CTO patients.
  • This cost-effective biomarker shows promise for risk stratification in CTO patients.
  • Further prospective validation is required for clinical application.
Abstract

Keywords:
HALP scoreWerner classificationchronic total occlusioncoronary collateral circulation

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