JOMPAC
Journal of Medicine and Palliative Care

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

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Original Article
Pan-immune inflammation value as a determinant of coronary collateral circulation in patients with chronic coronary syndrome and chronic total occlusion
Abstract
Aims: This study aimed to investigate the association between coronary collateral circulation (CCC) pan-immune-inflammation value (PIV) in patients with chronic coronary syndrome (CCS) and chronic total occlusion (CTO).
Methods: The study included 297 patients with CCS who underwent coronary angiography and had CTO in at least one major coronary artery. Patients with CTO were categorized into two groups based on Rentrop grading: group 1 (grades 2–3, well developed CCC) and group 2 (grades 0–1, poor CCC).
Results: Patients with poor CCC had higher WBC levels (p=0.04), neutrophil counts (p=0.001), platelet counts (p=0.023), and median PIV values (p=0.003) compared to patients with well-developed CCC. Logistic regression identified PIV (per hundred units) as an independent predictor of poor CCC (OR=1.10, 95% [CI=1.02–1.23], p=0.044). Receiver operating characteristic (ROC) analysis demonstrated that a cut-off value of 168 for PIV predicted poor CCC slightly better compared to other markers, with 94.6% sensitivity and 22.8% specificity (area under the curve=0.601, 95% CI=0.543–0.657, p=0.002).
Conclusion: These findings indicate that PIV may serve as an independent predictor of CCC development.

Keywords : Coronary collateral circulation, pan-immune-inflammation value, chronic coronary syndrome, chronic total occlusion

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1. Abajobir AA, Abate KH, Abbafati C, et al. Global, regional and National incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1211-1259. doi:10.1016/S0140-6736(17)32154-2
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10. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-270. doi:10.1093/ehjci/jev014
11. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989;2(5):358-367. doi:10.1016/s0894-7317(89) 80014-8
12. Rentrop KP, Cohen M, Blank H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985; 5(3):587-592. doi:10.1016/s0735-1097(85)80380-6
13. Jamaiyar A, Juguilon C, Dong F, et al. Cardioprotection during ischemia by coronary collateral growth. Am J Physiol Heart Circ Physiol. 2019; 316(1):H1–H9. doi:10.1152/ajpheart.00145.2018
14. Seiler C, Stoller M, Pitt B, Meier P. The human coronary collateral circulation: development and clinical importance. Eur Heart J. 2013; 34(34):2674-2682. doi:10.1093/eurheartj/eht195
15. Hein TW, Singh U, Vasquez-Vivar J, Devaraj S, Kuo L, Jialal I. Human C-reactive protein induces endothelial dysfunction and uncoupling of eNOS in vivo. Atherosclerosis. 2009;206(1):61-68. doi:10.1016/j.atherosclerosis.2009.02.002
16. Khmelewski E, Becker A, Meinertz T, Ito WD. Tissue resident cells play a dominant role in arteriogenesis and concomitant macrophage accumulation. Circul Res. 2004;95(6):E56-64. doi:10.1161/01.RES. 0000143013.04985.E7
17. la Sala A, Pontecorvo L, Agresta A, Rosano G, Stabile E. Regulation of collateral blood vessel development by the innate and adaptive immune system. Trends Mol Med. 2012;18(8):494-501. doi:10.1016/j.molmed. 2012.06.007
18. Murat B, Murat S, Ozgeyik M, Bilgin M. Comparison of pan-immune-inflammation value with other inflammation markers of long-term survival after ST-segment elevation myocardial infarction. Eur J Clin Invest. 2023;53(1):e13872. doi:10.1111/eci.13872
19. Çetinkaya Z, Keleşoğlu S, Tuncay A, et al. The role of pan-immune-inflammation value in determining the severity of coronary artery disease in NSTEMI patients. J Clin Med. 2024;13(5):1295. doi:10.3390/jcm13051295
20. Kelesoglu S, Yilmaz Y, Elcık D. Relationship between C-reactive protein to albumin ratio and coronary collateral circulation in patients with stable coronary artery disease. Angiology. 2021;72(9):829-835. doi:10. 1177/00033197211004392
21. Zhang B, Li Y, Peng A, et al. Association between the pan-immune-inflammation value and coronary collateral circulation in chronic total coronary occlusive patients. BMC Cardiovasc Disord. 2024;24(1):458. doi:10.1186/s12872-024-04139-9
22. Yilmaz Y, Kelesoglu S. The importance of pan-immune inflammation value (PIV) in predicting coronary collateral circulation in stable coronary artery patients. Angiology. 2024:33197241258529. doi:10.1177/ 00033197241258529
23. Wu B, Zhang C, Lin S, et al. The relationship between the pan-immune-inflammation value and long-term prognoses in patients with hypertension: national health and nutrition examination study, 1999–2018. Front Cardiovasc Med. 2023;10:1099427. doi:10.3389/fcvm.2023. 1099427
1. Abajobir AA, Abate KH, Abbafati C, et al. Global, regional and National incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390(10100):1211-1259. doi:10.1016/S0140-6736(17)32154-2
2. Meier P, Schirmer SH, Lansky AJ, et al. The collateral circulation of the heart. BMC Med. 2013;11(1):143. doi:10.1186/1741-7015-11-143
3. Elias J, Hoebers LPC, van Dongen IM, Claessen BEPM, Henriques JPS. Impact of collateral circulation on survival in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with a concomitant chronic total occlusion. JACC Cardiovasc Interv. 2017;10(9):906-914. doi:10.1016/j.jcin.2017.01.026
4. Masahiko H, Yasuhiko S, Daisaku N, et al. Impact of coronary collaterals on in-hospital and 5-year mortality after ST-elevation myocardial infarction in the contemporary percutaneous coronary intervention era: a prospective observational study. BMJ Open. 2016;6(7):e011105. doi:10.1136/bmjopen-2016-011105
5. Kurtul A, Duran M. The correlation between lymphocyte/monocyte ratio and coronary collateral circulation in stable coronary artery disease patients. Biomark Med. 2017;11(1):43-52. doi:10.2217/bmm-2016-0179
6. Nacar AB, Erayman A, Kurt M, et al. The relationship between coronary collateral circulation and neutrophil/lymphocyte ratio in patients with coronary chronic total occlusion. Med Princ Pract. 2015;24(1):65-69. doi:10.1159/000365734
7. Galassi AR, Werner GS, Boukhris M, et al. Percutaneous recanalisation of chronic total occlusions: 2019 consensus document from the Euro CTO Club. EuroIntervention. 2019;15(2):198-208. doi:10.4244/EIJ- D- 18-00826
8. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36): 3415-3537. doi:10.1093/eurheartj/ehae177
9. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37:2315-2381. doi:10.1016/j.atherosclerosis.2016.05.037
10. Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-270. doi:10.1093/ehjci/jev014
11. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr. 1989;2(5):358-367. doi:10.1016/s0894-7317(89) 80014-8
12. Rentrop KP, Cohen M, Blank H, Phillips RA. Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol. 1985; 5(3):587-592. doi:10.1016/s0735-1097(85)80380-6
13. Jamaiyar A, Juguilon C, Dong F, et al. Cardioprotection during ischemia by coronary collateral growth. Am J Physiol Heart Circ Physiol. 2019; 316(1):H1–H9. doi:10.1152/ajpheart.00145.2018
14. Seiler C, Stoller M, Pitt B, Meier P. The human coronary collateral circulation: development and clinical importance. Eur Heart J. 2013; 34(34):2674-2682. doi:10.1093/eurheartj/eht195
15. Hein TW, Singh U, Vasquez-Vivar J, Devaraj S, Kuo L, Jialal I. Human C-reactive protein induces endothelial dysfunction and uncoupling of eNOS in vivo. Atherosclerosis. 2009;206(1):61-68. doi:10.1016/j.atherosclerosis.2009.02.002
16. Khmelewski E, Becker A, Meinertz T, Ito WD. Tissue resident cells play a dominant role in arteriogenesis and concomitant macrophage accumulation. Circul Res. 2004;95(6):E56-64. doi:10.1161/01.RES. 0000143013.04985.E7
17. la Sala A, Pontecorvo L, Agresta A, Rosano G, Stabile E. Regulation of collateral blood vessel development by the innate and adaptive immune system. Trends Mol Med. 2012;18(8):494-501. doi:10.1016/j.molmed. 2012.06.007
18. Murat B, Murat S, Ozgeyik M, Bilgin M. Comparison of pan-immune-inflammation value with other inflammation markers of long-term survival after ST-segment elevation myocardial infarction. Eur J Clin Invest. 2023;53(1):e13872. doi:10.1111/eci.13872
19. Çetinkaya Z, Keleşoğlu S, Tuncay A, et al. The role of pan-immune-inflammation value in determining the severity of coronary artery disease in NSTEMI patients. J Clin Med. 2024;13(5):1295. doi:10.3390/jcm13051295
20. Kelesoglu S, Yilmaz Y, Elcık D. Relationship between C-reactive protein to albumin ratio and coronary collateral circulation in patients with stable coronary artery disease. Angiology. 2021;72(9):829-835. doi:10. 1177/00033197211004392
21. Zhang B, Li Y, Peng A, et al. Association between the pan-immune-inflammation value and coronary collateral circulation in chronic total coronary occlusive patients. BMC Cardiovasc Disord. 2024;24(1):458. doi:10.1186/s12872-024-04139-9
22. Yilmaz Y, Kelesoglu S. The importance of pan-immune inflammation value (PIV) in predicting coronary collateral circulation in stable coronary artery patients. Angiology. 2024:33197241258529. doi:10.1177/ 00033197241258529
23. Wu B, Zhang C, Lin S, et al. The relationship between the pan-immune-inflammation value and long-term prognoses in patients with hypertension: national health and nutrition examination study, 1999–2018. Front Cardiovasc Med. 2023;10:1099427. doi:10.3389/fcvm.2023. 1099427
Article available in :
Volume 6, Issue 3, 2025
Page : 219-223
https://doi.org/10.47582/jompac.1625998
Article Information
Received : 23 Oca 2025
Accepted : 29 Nis 2025
Published : 18 Haz 2025
Corresponding Author :

Mehmet Nail Bilen: Department of Cardiology, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkiye

[email protected]
Citation : Bilen MN, Genç Ö. Pan-immune inflammation value as a determinant of coronary collateral circulation in patients with chronic coronary syndrome and chronic total occlusion. J Med Palliat Care. 2025;6(3):219-223. doi:10.47582/jompac.1625998

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