Department of Cardiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, No. 2 Anzhen Street, Chaoyang District, Beijing, 100029, China.
Cardiovasc Diabetol. 2021 May 10;20(1):104. doi: 10.1186/s12933-021-01297-4.
Metabolic syndrome (MetS) is an independent risk factor for the incidence of cardiovascular diseases. We investigated whether or to what extent MetS and its components was associated with coronary collateralization (CC) in chronic total occlusion (CTO).
This study involved 1653 inpatients with CTO. Data on demographic and clinical characteristics were collected by cardiovascular doctors. The CC condition was defined by the Rentrop scoring system. Subgroup analysis, mixed model regression analysis, scoring systems and receiver operating characteristic (ROC) curve analysis were performed.
Overall, 1653 inpatients were assigned to the poor CC group (n = 355) and good CC group (n = 1298) with or without MetS. Compared to the good CCs, the incidence of MetS was higher among the poor CCs for all patients. Poor collateralization was present in 7.6%, 14.2%, 19.3%, 18.2%, 35.6% and 51.1% of the six groups who met the diagnostic criteria of MetS 0, 1, 2, 3, 4 and 5 times, respectively. For multivariable logistic regression, quartiles of BMI remained the risk factors for CC growth in all subgroups (adjusted OR = 1.755, 95% CI 1.510-2.038, P < 0.001 all patients; adjusted OR = 1.897, 95% CI 1.458-2.467, P < 0.001 non-MetS; and adjusted OR = 1.814, 95% CI 1.482-2.220, P < 0.001 MetS). After adjustment for potential confounding factors, MetS was an independent risk factor for CC growth in several models. Assigning a score of one for each component, the AUCs were 0.629 (95% CI 0.595-0.662) in all patients, 0.656 (95% CI 0.614-0.699) in MetS patients and 0.569 (95% CI 0.517-0.621) in non-MetS patients by receiver operating characteristic analysis.
MetS, especially body mass index, confers a greater risk of CC formation in CTO. The value of scoring systems should be explored further for CTO.
代谢综合征（MetS）是心血管疾病发病的独立危险因素。本研究旨在探讨 MetS 及其各组分与慢性完全闭塞（CTO）患者侧支循环（CC）形成的关系。
本研究纳入了 1653 例 CTO 住院患者。心血管医生收集了患者的人口统计学和临床特征数据。采用 Rentrop 评分系统定义 CC 情况。进行了亚组分析、混合模型回归分析、评分系统和受试者工作特征（ROC）曲线分析。
总体而言，1653 例患者被分为 CC 较差组（n=355）和 CC 较好组（n=1298），两组均存在或不存在 MetS。与 CC 较好的患者相比，MetS 在 CC 较差的患者中更为常见。在满足 MetS 0、1、2、3、4 和 5 次诊断标准的六组患者中，较差 CC 的发生率分别为 7.6%、14.2%、19.3%、18.2%、35.6%和 51.1%。多变量逻辑回归分析显示，BMI 四分位数在所有亚组中均为 CC 增长的危险因素（调整 OR=1.755，95%CI 1.510-2.038，P<0.001 所有患者；调整 OR=1.897，95%CI 1.458-2.467，P<0.001 非 MetS 患者；调整 OR=1.814，95%CI 1.482-2.220，P<0.001 MetS 患者）。在调整了潜在混杂因素后，MetS 是 CC 生长的独立危险因素。对各组分赋值 1 分，全患者人群的 AUC 为 0.629（95%CI 0.595-0.662），MetS 患者为 0.656（95%CI 0.614-0.699），非 MetS 患者为 0.569（95%CI 0.517-0.621）。
MetS，尤其是 BMI，增加了 CTO 患者 CC 形成的风险。评分系统的价值有待进一步探索。
