Association of serum cytokines with coronary chronic total occlusion (CTO) and their role in predicting procedural outcomes.

BACKGROUND: Cytokines are strongly associated with coronary artery disease (CAD); however, few studies have explored the relevance of cytokines in coronary chronic total occlusion (CTO). This study aimed to clarify the association of cytokines with CTO and its procedural outcomes.

METHODS: A total of 526 patients with suspected CAD but not acute myocardial infarction were enrolled and divided into CTO (n = 122) and non-CTO (n = 404) groups based on coronary angiography. Furthermore, serum levels of 12 cytokines [Interleukin-1β (IL-1β), IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17, tumor necrosis factor-α (TNF-α), interferon-α (IFN-α), and IFN-γ] were measured for each patient.

RESULTS: Patients with CTO had higher rates of male (P=0.001), smoking (P=0.014), and diabetes (P=0.008); higher levels of IL-6 (P<0.001), total triglycerides (P=0.020), serum creatine (P=0.001), and high-sensitivity troponin I (P=0.001); and lower IL-4 (P<0.001), total cholesterol (P=0.027), and high-density lipoprotein cholesterol (HDL-C) (P<0.001) levels compared to those without CTO. IL-4 (OR=0.216, 95%CI:0.135-0.345, P<0.001), IL-6 (OR=1.248, 95%CI:1.165-1.337, P<0.001), and HDL-C (OR=0.047, 95%CI:0.010-0.221, P<0.001) were identified as independent predictors of CTO. And good predictive performance (AUC=0.876) for CTO, with a sensitivity of 81.96% and specificity of 81.19%, could be achieved by combining these three predictors. Furthermore, patients with procedural success had younger age (P=0.004) and lower serum IL-6 levels (P=0.039) compared to those with procedural failure, and IL-6 levels (OR=0.962, 95%CI: 0.931-0.995, P=0.023) were associated with procedural success.

CONCLUSION: IL-4, IL-6, and HDL-C levels were strongly associated with CTO, and IL-6 also linked to procedural outcomes of CTO.