Relationship Between Coronary Collateral Circulation and the Neutrophil-Percentage-to-Albumin Ratio in Patients with Chronic Coronary Syndrome

<i>Background and Objectives:</i> The neutrophil-percentage-to-albumin ratio (NPAR) has been recognized as an independent risk factor for cardiovascular diseases. In our study, we investigated whether the NPAR is associated with the formation of coronary collateral circulation (CCC) in patients with chronic coronary syndrome (CCS). <i>Materials and Methods:</i> A total of 681 patients with CCS were included in this study. Of these patients, 571 had chronic total occlusion in at least one major vessel and developed collateral vessels. In total, 110 patients were in the control group, who had CCS but did not have complete occlusion in a major vessel and did not develop collateral vessels. Patients with collateral vessels on coronary angiography were divided into two groups according to the Rentrop score: poor CCC (Rentrop 0-1) and good CCC (Rentrop 2-3). Blood samples were taken for the NPAR and other biochemical parameters in all patients during hospitalization. The NPAR was calculated as the neutrophil-percentage-to-albumin ratio. <i>Results:</i> The group of patients with poor CCC had a higher white blood count (WBC), neutrophil, C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and NPAR values than patients with good CCC (<i>p</i> < 0.001, for all). Multivariate logistic regression analysis showed that high NPAR levels were an independent predictor of poor CCC (OR: 2.79, 95% CI:1.7-4.6, <i>p</i> < 0.001), accompanied by neutrophil, CRP, CAR, and NLR levels. In the receiver operator characteristic curve (ROC analysis), the cut-off value for the NPAR to indicate poor CCC was 1.78 with a sensitivity of 76.6% and specificity of 81.4% (area under ROC curve = 0.804 95% CI (0.753-0.854), <i>p</i> < 0.001). <i>Conclusions:</i> We demonstrated that the NPAR may be an independent predictor of poor CCC development in clinical practice.