An Independent Predictor of Technical Success in Patients with Chronic Total Occlusions: The Atherogenic Index of Plasma

OBJECTIVE: The atherogenic index of plasma (AIP) has been increasingly associated with coronary artery disease and adverse cardiovascular outcomes. This study aimed to evaluate the clinical relevance of AIP in predicting technical success in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). METHOD: This retrospective study included 197 patients who met the eligibility criteria. AIP was calculated as the base-10 logarithm of the triglyceride (TG)-to-high-density lipoprotein cholesterol (HDL-C) ratio (log10[TG/HDL-C]). Technical success was defined as successful recanalization of the CTO with residual stenosis < 30% and restoration of antegrade flow. RESULTS: Based on the receiver operating characteristic (ROC)-derived AIP cutoff value (0.802), patients were classified into low-AIP (n = 125, 64%) and high-AIP (n = 72, 36%) groups. Higher AIP levels were associated with lower technical success rates. To assess the incremental predictive value of AIP, two nested models (Model 1 and Model 2) were constructed. Model discrimination improved with the inclusion of AIP (area under the curve [AUC]: 0.73 vs. 0.83), and likelihood ratio testing confirmed a significant enhancement in model performance (P < 0.001). In both models, estimated glomerular filtration rate and the Japanese Chronic Total Occlusion (J-CTO) score remained independent predictors of CTO PCI technical success. In Model 2, AIP was also independently associated with technical success (odds ratio: 0.03, 95% confidence interval: 0.01-0.12, P < 0.001). Although AIP demonstrated a numerically higher AUC than the J-CTO score in ROC analysis for predicting CTO PCI success, the difference was not statistically significant (P = 0.097). CONCLUSION: AIP may serve as a useful predictor of technical success in chronic total occlusion percutaneous coronary intervention and may provide incremental value during procedural planning.