Association Between MIA3 and Coronary Collateral Circulation Formation in Patients with Chronic Total Occlusion

Abstract Objective: To investigate the correlation between melanoma inhibitory activity 3 (MIA3) and coronary collateral circulation (CCC) formation in patients with coronary chronic total occlusion (CTO). Methods: A total of 489 patients with CTO admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2021 to July 2022 were enrolled as study subjects. According to the Rentrop classification system, patients were divided into a poor CCC group and a good CCC group. Baseline clinical data were collected, and plasma levels of MIA3 and vascular endothelial growth factor A (VEGFA) were quantitatively measured. Multivariate logistic regression analysis was used to identify independent factors correlated with good CCC formation. Receiver operating characteristic (ROC) curves were plotted to evaluate the clinical value of predicting good CCC formation. The net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to assess the incremental predictive performance of MIA3 when added to traditional risk models. Clinical subgroup and interaction analyses were also performed. Results: Compared with the poor CCC group, patients in the good CCC group showed significantly higher plasma MIA3 levels (1280.87 pg/ml vs.1041.30 pg/ml, P < 0.001), with Rentrop grade 0 patients exhibiting the lowest MIA3 levels. Systolic blood pressure, diastolic blood pressure, body mass index (BMI), fasting plasma glucose, and hemoglobin A1c (HbA1c) levels were significantly lower in the good CCC group than in the poor group, and the proportions of patients with hypertension and diabetes mellitus were also lower. After adjusting for confounding factors using multivariate logistic regression, a high level of MIA3 (>1462.24pg/ml) was identified as an independent related factor for good CCC formation (OR= 3.152, P < 0.001). ROC curve analysis showed that the area under the curve (AUC) of plasma MIA3 in predicting good CCC was 0.630 (P < 0.001). NRI and IDI analyses demonstrated that adding MIA3 to traditional risk factors significantly improved the predictive efficiency of the model for CCC formation (both P < 0.05). Subgroup analysis revealed a significant interaction between MIA3 and dyslipidemia; among patients with dyslipidemia, higher MIA3 levels were associated with better CCC formation. Conclusion: MIA3 is an independent protective factor for good CCC formation in patients with CTO. Higher MIA3 levels are correlated with better collateral development, and this association is particularly prominent in patients with dyslipidemia. Incorporating MIA3 into traditional clinical models significantly enhances the predictive performance for good CCC formation in CTO patients.