Abstract
BACKGROUND: Coronary collateral circulation (CCC) plays a vital role in preserving myocardial perfusion in patients with chronic total occlusion (CTO). Reliable biomarkers for evaluating CCC are needed. This study aimed to investigate the combined diagnostic value of serum uric acid-to-albumin ratio (UAR) and C-reactive protein (CRP) in assessing the CCC status. METHODS: We enrolled 220 patients undergoing coronary angiography and categorized them into three groups: CTO (n = 80), coronary heart disease (CHD, n = 100), and controls (n = 40). Serum UAR and CRP levels were measured. Logistic regression and receiver operating characteristic curve analyses were performed to determine associations with CCC quality. RESULTS: UAR and CRP levels were significantly elevated in the CTO group compared to CHD and control groups. Among CTO patients, those with well-developed CCC had significantly lower UAR and CRP levels. Both biomarkers were identified as independent predictors of the CCC status. Combined use of CRP and UAR improved diagnostic specificity to 91.1%. CONCLUSION: This is the first study to demonstrate the diagnostic utility of combining UAR and CRP for evaluating CCC in CTO patients. The dual-marker approach enhances diagnostic accuracy and may support more precise clinical decision-making in coronary artery disease.