Association between high-density lipoprotein-related inflammatory indices and coronary collateral circulation in patients with chronic total occlusion

ZHANG Yin-zhu; CHENG Meng-yao; BAI Ming

doi:10.3969/j.issn.1672-5301.2026.02.008

Abstract：Objective To investigate the association between high-density lipoprotein-related inflammatory indices(HDL-related inflammatory indices)and the formation of coronary collateral circulation(CCC)in patients with chronic total occlusion(CTO).Methods We consecutively enrolled 845 CTO patients admitted to the Heart Center of the First Hospital of Lanzhou University between January 2024 and June 2025.Based on the Rentrop classification,patients were divided into the good CCC group(n=509)and the poor CCC group(n=336).We compared baseline clinical characteristics between the two groups and calculated HDL-related inflammatory indices,including the neutrophil-to-HDL ratio(NHR),monocyte-to-HDL ratio(MHR),lymphocyte-to-HDL ratio(LHR),leukocyte-to-HDL ratio(WHR),and platelet-to-HDL ratio(PHR).Logistic regression models were used to assess the association between NHR and poor CCC formation,and multiple adjusted models were constructed to test the robustness of the findings.Receiver operating characteristic(ROC)curve and restricted cubic spline(RCS)analyses were performed to evaluate the predictive value and dose-response relationship,respectively.Subgroup analyses were also conducted.Results Compared to the good CCC group,patients in the poor CCC group had higher levels of body mass index,C-reactive protein(CRP),fasting glucose and triglycerides,while HDL levels were lower[0.950(0.840,1.110)mmol/L vs.1.000(0.840,1.180)mmol/L](all P<0.05).Among HDL-related inflammatory indices,NHR[4.500(3.350,6.023)vs.3.939(2.892,5.341)],WHR[6.741(5.330,8.348)vs.6.259(4.879,8.363)],and MHR[0.395(0.302,0.531)vs.0.372(0.274,0.500)]were significantly higher in the poor CCC group(all P<0.05),while LHR and PHR showed no significant differences.Univariate analysis indicated that BMI,CRP,serum creatinine,fasting glucose,and NHR were significantly associated with poor CCC.Multivariate analysis identified BMI,CRP,fasting glucose,and NHR as independent risk factors.Across all adjusted models,NHR consistently remained an independent predictor of poor CCC(Model 3:OR=1.094,95%CI 1.027-1.166,P<0.001).When stratified by tertiles,the high NHR group demonstrated a markedly increased risk of poor CCC.ROC analysis revealed a limited predictive ability of NHR alone(AUC=0.588),which improved to 0.711 after incorporating NHR into the baseline model(P<0.05).RCS analysis demonstrated a nonlinear positive association between NHR and poor CCC formation,revealing a threshold effect indicating that when NHR<2.92,the risk of poor CCC increased significantly with rising NHR levels(OR=2.26,95%CI 1.37-3.72,P<0.001).Subgroup analysis showed that the association between NHR and poor CCC formation was consistent across most subgroups,except for a significant interaction in patients with hypertension.Conclusions Elevated NHR is closely associated with impaired CCC formation in patients with CTO.NHR may serve as a simple and practical inflammatory biomarker for evaluating CCC development,providing valuable insights for risk stratification and clinical management of CTO patients.