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Higher SII and FAR levels associated with poorly-developed coronary collateral circulation in CTO patientsHigher Inflammation Markers Linked to Poorer Blood Flow Around Blocked Heart Arteries

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Key Takeaway
Note that higher SII and FAR levels associate with poorly-developed coronary collateral circulation in CTO patients.

This retrospective cohort analysis examined 469 patients with coronary chronic total occlusion who underwent elective coronary angiography. The study investigated the association between systemic immune-inflammation index (SII) and fibrinogen-to-albumin ratio (FAR) levels with the development of coronary collateral circulation (CCC). Patients were categorized based on whether they had well-developed or poorly-developed CCC.

In multivariate logistic regression analysis, SII levels were significantly higher in the poorly-developed CCC group compared to the well-developed CCC group. The odds ratio was 3.121 (95% CI: 1.827–5.537). Similarly, FAR levels were significantly higher in the poorly-developed CCC group, with an identical odds ratio of 3.121 (95% CI: 1.827–5.537).

No adverse events, serious adverse events, discontinuations, or tolerability data were reported in this analysis. The study design is observational, meaning causal inference cannot be made. Results are specific to patients with coronary chronic total occlusion undergoing elective coronary angiography and may not be generalizable to other populations or settings.

Clinicians should interpret these biomarkers as potential indicators of collateral development status in this specific patient population. Further prospective research is needed to validate these associations and determine clinical utility for risk stratification or therapeutic monitoring in chronic total occlusion management.

This study examined 469 patients who had coronary chronic total occlusion and underwent elective coronary angiography. The researchers measured two specific markers: the systemic immune-inflammation index (SII) and the fibrinogen-to-albumin ratio (FAR). They compared patients who had well-developed collateral circulation with those who had poorly-developed circulation.

The analysis showed that patients with poorly-developed collateral circulation had significantly higher levels of both SII and FAR. In statistical terms, higher levels of these markers were associated with an odds ratio of 3.121 for having poorly-developed circulation. This suggests a strong link between these inflammation markers and the extent of natural blood flow development around the blockage.

No safety concerns were reported because the study did not track side effects or drug discontinuations. Readers should understand that this is an observational study, meaning it can only show connections, not cause-and-effect relationships. These findings are specific to this group of patients and may not apply to everyone else.

The main takeaway is that these inflammation markers might help doctors identify patients with less developed collateral flow. However, more research is needed to confirm these results in different settings before they can change how heart care is provided.

What this means for you:
Higher inflammation markers were linked to poorer blood flow development in 469 patients with blocked heart arteries.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedMar 2026
View Original Abstract ↓
BackgroundCoronary collateral circulation (CCC) plays a vital compensatory role in maintaining myocardial perfusion in patients with chronic total occlusion (CTO) of the coronary arteries. Systemic inflammation and nutritional status are known to influence arteriogenesis; however, the roles of the systemic immune-inflammation index (SII) and the fibrinogen-to-albumin ratio (FAR) in CCC formation remain underexplored.ObjectiveThis study aimed to evaluate the association between SII and FAR levels and the development of CCC in patients with CTO.MethodsA retrospective analysis was conducted on 469 patients with coronary chronic total occlusion who underwent elective coronary angiography. Patients were stratified into poorly-developed and well-developed CCC groups based on the Rentrop collateral grading system. Baseline clinical characteristics, laboratory biomarkers, and angiographic findings were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of poorly-developed CCC. The predictive value of SII and FAR, both individually and in combination, was evaluated using receiver operating characteristic (ROC) curve analysis.ResultsPatients with poorly-developed CCC exhibited significantly higher levels of SII and FAR compared to those with well-developed CCC. In multivariate logistic regression, both SII [odds ratio [OR] = 3.121, 95% confidence interval [CI]: 1.827–5.537, P 
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