{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T05:08:50Z","timestamp":1779426530331,"version":"3.53.1"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The single-point insulin sensitivity estimator (SPISE) is a novel metric used to assess insulin resistance. However, its association with collateral circulation impairment in patients with chronic total occlusion (CTO) remains unclear. This study aims to investigate the relationship between SPISE, high-sensitivity C-reactive protein (hs-CRP), and collateral circulation impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Logistic regression models, restricted cubic spline (RCS) models, and subgroup analyses were utilized to explore the associations between SPISE, hs-CRP, and collateral circulation impairment. The predictive capability was evaluated using receiver operating characteristic (ROC) curves. Both base and extended models were constructed, and the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices were calculated to assess the incremental predictive value of the additional biomarkers. A mediation effect model was employed to analyze the mediating role of hs-CRP in the relationship between SPISE and collateral circulation impairment. Additionally, the proportional scaling method was used to determine the weights of SPISE and hs-CRP, and a composite score was developed for sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 362 participants were included in this study. After adjusting for all covariates, SPISE was negatively associated with collateral circulation impairment (OR = 0.371, 95% CI 0.245-0.543, P&amp;lt;0.001), while hs-CRP was positively associated with collateral circulation impairment (OR = 2.133, 95% CI 1.617-2.872, P&amp;lt;0.001). These associations remained consistent across most subgroups, with both SPISE and hs-CRP showing a linear relationship with collateral circulation impairment. The area under the curve (AUC) for SPISE in predicting collateral circulation impairment was 0.730 (95% CI 0.677-0.782), and the AUC for hs-CRP was 0.739 (95% CI 0.685-0.795). After adding SPISE and hs-CRP to the base model, the predictive ability of the extended model significantly improved, with the AUC increasing from 0.763 (95% CI 0.713-0.814) to 0.872 (95% CI 0.835-0.908). The continuous NRI was 0.794 (95% CI 0.592-1.096) and the IDI was 0.197 (95% CI 0.127-0.284). Mediation analysis indicated that hs-CRP partially mediated the relationship between SPISE and collateral circulation impairment, with a mediation proportion of 27% (P&amp;lt;0.001) after multivariable adjustment. Sensitivity analysis incorporating the SPISE-hs-CRP composite score into the base model to construct the extended model yielded consistent results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The SPISE and hs-CRP are not only significantly associated with the risk of collateral circulation impairment, but their inclusion in the base model also leads to a significant improvement in the model\u2019s risk stratification ability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1835713","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T04:36:35Z","timestamp":1779424595000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The association between single-point insulin sensitivity estimator and high-sensitivity C-reactive protein with collateral circulation in coronary chronic total occlusion"],"prefix":"10.3389","volume":"17","author":[{"given":"Yazhao","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Cardiology, Cangzhou People\u2019s Hospital","place":["Cangzhou, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurology Intervention, Cangzhou People\u2019s Hospital","place":["Cangzhou, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunlan","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cangzhou People\u2019s Hospital","place":["Cangzhou, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurology Intervention, Cangzhou People\u2019s Hospital","place":["Cangzhou, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.104.481283","article-title":"Percutaneous recanalization of chronically occluded coronary arteries: a consensus document: part I","volume":"112","author":"Stone","year":"2005","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/s12933-021-01297-4","article-title":"Metabolic syndrome and its components reduce coronary collateralization in chronic total occlusion: an observational study","volume":"20","author":"Liu","year":"2021","journal-title":"Cardiovasc Diabetol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.2147\/DMSO.S402849","article-title":"Hyperinsulinemia impaired coronary collateral circulation in patients with chronic total coronary occlusion","volume":"16","author":"Zou","year":"2023","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn569","article-title":"Metabolic syndrome and collateral vessel formation in patients with documented occluded coronary arteries: association with hyperglycaemia, insulin-resistance, adiponectin and plasminogen activator inhibitor-1","volume":"30","author":"Mouquet","year":"2009","journal-title":"Eur Heart J"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1373\/clinchem.2016.257436","article-title":"Modification and validation of the triglyceride-to-HDL cholesterol ratio as a surrogate of insulin sensitivity in white juveniles and adults without diabetes mellitus: the single point insulin sensitivity estimator (SPISE)","volume":"62","author":"Paulmichl","year":"2016","journal-title":"Clin Chem"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1159\/000365734","article-title":"The relationship between coronary collateral circulation and neutrophil\/lymphocyte ratio in patients with coronary chronic total occlusion","volume":"24","author":"Nacar","year":"2015","journal-title":"Med Princ Pract"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3109\/07853890.2015.1136429","article-title":"C-reactive protein as a predictor for poor collateral circulation in patients with chronic stable coronary heart disease","volume":"48","author":"Fan","year":"2016","journal-title":"Ann Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1177\/1076029613503399","article-title":"The relationship between neutrophil-to-lymphocyte ratio and coronary collateral circulation","volume":"21","author":"Uysal","year":"2015","journal-title":"Clin Appl Thromb Hemost"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2024.1490498","article-title":"Elevated systemic immune-inflammatory index predicts poor coronary collateralization in type 2 diabetic patients with chronic total occlusion","volume":"11","author":"Mao","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"20251299","DOI":"10.1515\/med-2025-1299","article-title":"Serum uric acid to albumin ratio and C-reactive protein as predictive biomarkers for chronic total occlusion and coronary collateral circulation quality","volume":"20","author":"Zhao","year":"2025","journal-title":"Open Med (Wars)"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/jcm15010148","article-title":"The relationship between collateral circulation and electrocardiographic frontal QRS-T angle in patients with coronary artery chronic total occlusion","volume":"15","author":"\u00d6zt\u00fcrk","year":"2025","journal-title":"J Clin Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(88)91048-x","article-title":"Determinants and protective potential of coronary arterial collaterals as assessed by an angioplasty model","volume":"61","author":"Rentrop","year":"1988","journal-title":"Am J Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1016\/0002-8703(78)90372-1","article-title":"The functional value of coronary collaterals in myocardial ischemia and therapeutic approach to enhance collateral flow","volume":"95","author":"Cohen","year":"1978","journal-title":"Am Heart J"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.numecd.2023.10.036","article-title":"Association between the triglyceride glucose index and chronic total coronary occlusion: a cross-sectional study from southwest China","volume":"34","author":"Xiao","year":"2024","journal-title":"Nutr Metab Cardiovasc Dis"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1080\/00015385.2026.2626609","article-title":"Assessment of the relationship between J-CTO score and triglyceride-glucose index in patients with chronic total occlusion","volume":"81","author":"G\u00fcrses","year":"2026","journal-title":"Acta Cardiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s12933-023-02080-3","article-title":"Correlation between triglyceride glucose index and collateral circulation formation in patients with chronic total occlusion of coronary arteries in different glucose metabolic states","volume":"23","author":"Zhu","year":"2024","journal-title":"Cardiovasc Diabetol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1186\/s12933-023-02037-6","article-title":"Triglyceride-glucose index in the prediction of clinical outcomes after successful recanalization for coronary chronic total occlusions","volume":"22","author":"Yang","year":"2023","journal-title":"Cardiovasc Diabetol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1186\/s12944-021-01574-x","article-title":"Association between the triglyceride glucose index and coronary collateralization in coronary artery disease patients with chronic total occlusion lesions","volume":"20","author":"Gao","year":"2021","journal-title":"Lipids Health Dis"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s12291-021-00992-z","article-title":"Single-point insulin sensitivity estimator (SPISE) as a feasible marker of insulin resistance in adult metabolic syndrome: evaluated in a hospital based cross-sectional pilot study at tertiary care centre of Uttarakhand","volume":"37","author":"Rabari","year":"2022","journal-title":"Indian J Clin Biochem"},{"key":"B20","article-title":"Hematological parameters and coronary collateral circulation in patients with stable coronary artery disease","volume":"18","author":"Ayhan","year":"2013","journal-title":"Exp Clin Cardiol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1177\/00033197211004392","article-title":"Relationship between C-reactive protein to albumin ratio and coronary collateral circulation in patients with stable coronary artery disease","volume":"72","author":"Kelesoglu","year":"2021","journal-title":"Angiology"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1177\/02676591211014822","article-title":"Systemic immune inflammation index: a novel predictor for coronary collateral circulation","volume":"37","author":"Kelesoglu","year":"2022","journal-title":"Perfusion"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.14744\/AnatolJCardiol.2025.4987","article-title":"Neutrophil percentage-to-albumin ratio as a predictor of collateral circulation in chronic total occlusion","volume":"29","author":"Akta\u015f","year":"2025","journal-title":"Anatol J Cardiol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1038\/nm0206-171","article-title":"Angiogenesis and inflammation face off","volume":"12","author":"Imhof","year":"2006","journal-title":"Nat Med"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1172\/JCI117557","article-title":"Nitric oxide mediates angiogenesis in vivo and endothelial cell growth and migration in vitro promoted by substance P","volume":"94","author":"Ziche","year":"1994","journal-title":"J Clin Invest"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000029802.88087.5e","article-title":"A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis","volume":"106","author":"Verma","year":"2002","journal-title":"Circulation"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.5152\/akd.2012.250","article-title":"Determinants of coronary collateral circulation in patients with coronary artery disease","volume":"13","author":"Zorkun","year":"2013","journal-title":"Anadolu Kardiyol Derg"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.5551\/jat.3004","article-title":"Chronic CRP-exposure inhibits VEGF-induced endothelial cell migration","volume":"17","author":"Schneeweis","year":"2010","journal-title":"J Atheroscler Thromb"},{"key":"B29","doi-asserted-by":"publisher","first-page":"18417","DOI":"10.1038\/s41598-020-75390-1","article-title":"Synergistic association of high-sensitivity C-reactive protein and body mass index with insulin resistance in non-diabetic adults","volume":"10","author":"Kim","year":"2020","journal-title":"Sci Rep"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1835713\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T04:36:45Z","timestamp":1779424605000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1835713\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,22]]},"references-count":29,"alternative-id":["10.3389\/fendo.2026.1835713"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1835713","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,22]]},"article-number":"1835713"}}