{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T12:12:40Z","timestamp":1790079160025,"version":"4.0.1"},"reference-count":33,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:00:00Z","timestamp":1790035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background and Objectives: Although chronic total occlusion (CTO) often presents with varying degrees of coronary collateral circulation (CCC), the biological factors accompanying inadequate collateralization are not fully established. The Remnant Cholesterol Inflammation Index (RCII) is a composite metric integrating atherogenic lipid load and systemic inflammation. This study examined the association between RCII and CCC and the discriminative ability of RCII for identifying insufficient collateral networks in patients with CTO. Materials and Methods: This retrospective, single-center analysis evaluated 359 patients with at least one major epicardial CTO who underwent diagnostic coronary angiography between 15 January 2023 and 15 January 2026. Participants were stratified via the Rentrop scoring system into poor (grades 0\u20131; n = 168) and good (grades 2\u20133; n = 191) CCC cohorts. RCII was calculated as [remnant cholesterol (mg\/dL) \u00d7 high-sensitivity C-reactive protein (hs-CRP, mg\/L)]\/10, with remnant cholesterol derived as total cholesterol minus LDL-C and HDL-C. Univariable and multivariable logistic regression models, together with receiver operating characteristic (ROC) curve analysis, were used to assess the association of RCII with poor CCC and its discriminative ability. Results: Patients with poor CCC exhibited significantly higher RCII values compared with the good CCC cohort (19.7 \u00b1 4.7 vs. 6.5 \u00b1 2.4, p &lt; 0.001). Following multivariable adjustment, higher RCII remained independently associated with poor collateralization (OR 1.120, 95% CI 1.052\u20131.199; p &lt; 0.001), alongside right coronary artery (RCA) CTO and the systemic immune-inflammation index (SII). RCII showed discriminative ability for poor CCC (AUC 0.792, 95% CI 0.745\u20130.835; p &lt; 0.001), which was greater than that of remnant cholesterol, hs-CRP, or SII considered separately. In this cohort, an RCII threshold above 12.3 identified poor CCC with 80% sensitivity and 71% specificity. Conclusions: In this retrospective cohort, higher RCII was independently associated with inadequate coronary collateralization in the setting of CTO. RCII may represent a candidate marker of the combined residual lipid and inflammatory burden; prospective studies and external validation, together with formal assessment of clinical utility, are required before any clinical application can be considered.<\/jats:p>","DOI":"10.3390\/jcm15197352","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:09:35Z","timestamp":1790075375000},"page":"7352","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Relationship Between the Remnant Cholesterol Inflammation Index and Coronary Collateral Circulation in Patients with Chronic Total Occlusion"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5882-3534","authenticated-orcid":false,"given":"Erdo\u011fan","family":"Ya\u015far","sequence":"first","affiliation":[{"name":"Department of Cardiology, Malatya Training and Research Hospital, 44090 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"\u0130brahim","family":"Akta\u015f","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Malatya Turgut \u00d6zal University, 44090 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4981-5521","authenticated-orcid":false,"given":"Tolga","family":"\u00c7akmak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Bal\u0131kesir Atat\u00fcrk State Hospital University of Health Sciences, 10100 Bal\u0131kesir, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8159-181X","authenticated-orcid":false,"given":"Furkan","family":"Ay","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Faculty of Medicine, Malatya Turgut \u00d6zal University, 44090 Malatya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"key":"ref_1","unstructured":"(2024). GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet, 403, 2100\u20132132."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1016\/j.jacc.2011.12.007","article-title":"Current perspectives on coronary chronic total occlusions: The Canadian Multicenter Chronic Total Occlusions Registry","volume":"59","author":"Fefer","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2674","DOI":"10.1093\/eurheartj\/eht195","article-title":"The human coronary collateral circulation: Development and clinical importance","volume":"34","author":"Seiler","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1093\/eurheartj\/ehr308","article-title":"The impact of the coronary collateral circulation on mortality: A meta-analysis","volume":"33","author":"Meier","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Meier, P., Schirmer, S.H., Lansky, A.J., Timmis, A., Pitt, B., and Seiler, C. (2013). The collateral circulation of the heart. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-143"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Neshat, N., Shayestehyekta, H., Moradi, M., Frishman, W.H., and Aronow, W.S. (2025). Coronary Collaterals: A Comprehensive Review. Cardiol. Rev., Online ahead of print.","DOI":"10.1097\/CRD.0000000000001125"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"le Noble, F., and Kupatt, C. (2022). Interdependence of Angiogenesis and Arteriogenesis in Development and Disease. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23073879"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yalcin, M.U., Gurses, K.M., Aydo\u011fan, C., Butun, S., Tun\u00e7ez, A., Tezcan, H., Ozen, Y., Demir, K., Aygul, N., and Kirmizigul, M. (2026). Endothelial Activation and Stress Index Predicts Poor Coronary Collateral Development in Chronic Total Occlusion. J. Cardiovasc. Dev. Dis., 13.","DOI":"10.3390\/jcdd13030124"},{"key":"ref_9","first-page":"489","article-title":"Neutrophil Percentage-to-Albumin Ratio as a Predictor of Collateral Circulation in Chronic Total Occlusion","volume":"29","author":"Karasu","year":"2025","journal-title":"Anatol. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"605","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":"ref_11","doi-asserted-by":"crossref","first-page":"65","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":"ref_12","doi-asserted-by":"crossref","unstructured":"Toprak, K., and Karata\u015f, M. (2025). Exploring the impact of pan-immune-inflammation-value and other traditional inflammation-based markers on coronary collateral circulation in patients with chronic total occlusion. BMC Cardiovasc. Disord., 25.","DOI":"10.1186\/s12872-025-05296-1"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.jacc.2012.08.1026","article-title":"Remnant cholesterol as a causal risk factor for ischemic heart disease","volume":"61","author":"Varbo","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1161\/CIRCULATIONAHA.113.003008","article-title":"Elevated remnant cholesterol causes both low-grade inflammation and ischemic heart disease, whereas elevated low-density lipoprotein cholesterol causes ischemic heart disease without inflammation","volume":"128","author":"Varbo","year":"2013","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wang, K., Wang, R., Yang, J., Liu, X., Shen, H., Sun, Y., Zhou, Y., Fang, Z., and Ge, H. (2022). Remnant cholesterol and atherosclerotic cardiovascular disease: Metabolism, mechanism, evidence, and treatment. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.913869"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s13098-022-00829-6","article-title":"Increased estimated remnant-like particle cholesterol is associated with impaired coronary collateralization in patients with coronary chronic total occlusions","volume":"14","author":"Gao","year":"2022","journal-title":"Diabetol. Metab. Syndr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"117141","DOI":"10.1016\/j.atherosclerosis.2023.05.010","article-title":"Dual elevated remnant cholesterol and C-reactive protein in myocardial infarction, atherosclerotic cardiovascular disease, and mortality","volume":"379","author":"Doi","year":"2023","journal-title":"Atherosclerosis"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"587","DOI":"10.4093\/dmj.2025.0305","article-title":"Association of Remnant Cholesterol Inflammation Index with Cardiovascular Risks and All-Cause Mortality in Individuals with Diabetes or Prediabetes","volume":"50","author":"Ma","year":"2025","journal-title":"Diabetes Metab. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/j.jare.2024.12.015","article-title":"Predictive value of remnant cholesterol inflammatory index for stroke risk: Evidence from the China Health and Retirement Longitudinal Study","volume":"76","author":"Chen","year":"2025","journal-title":"J. Adv. Res."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Akta\u015f, \u0130., Ya\u015far, E., and U\u00e7ka\u00e7, K. (2026). Association Between the Remnant Cholesterol Inflammation Index and Cardiac Syndrome X. Diagnostics, 16.","DOI":"10.3390\/diagnostics16081113"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3912","DOI":"10.1093\/eurheartj\/ehae178","article-title":"2024 ESC Guidelines for the management of elevated blood pressure and hypertension","volume":"45","author":"McEvoy","year":"2024","journal-title":"Eur. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee (2025). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes\u20142025. Diabetes Care, 48, S27\u2013S49.","DOI":"10.2337\/dc25-S002"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"11","DOI":"10.21037\/jlpm-22-70","article-title":"Remnant cholesterol: New outcomes highlight its potential as a clinically useful cardiovascular risk factor","volume":"8","author":"Ferrer","year":"2023","journal-title":"J. Lab. Precis. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/s12944-025-02580-z","article-title":"Remnant cholesterol inflammatory index and its association with all-cause and cause-specific mortality in middle-aged and elderly populations: Evidence from US and Chinese national population surveys","volume":"24","author":"Wang","year":"2025","journal-title":"Lipids Health Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1177\/0271678X251317880","article-title":"Genetic determinants of insufficiency of the collateral circulation","volume":"46","author":"Faber","year":"2025","journal-title":"J. Cereb. Blood Flow Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s11886-021-01460-z","article-title":"New Research Is Shining Light on How Collateral Arteries Form in the Heart: A Future Therapeutic Direction?","volume":"23","author":"Das","year":"2021","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Zhang, B., Li, Y., Peng, A., Liu, C., Lin, J., Feng, Y., and Wan, J. (2024). Association between the pan-immune-inflammation value and coronary collateral circulation in chronic total coronary occlusive patients. BMC Cardiovasc. Disord., 24.","DOI":"10.1186\/s12872-024-04139-9"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1161\/CIRCULATIONAHA.108.816454","article-title":"Vascular endothelial growth factor-B induces myocardium-specific angiogenesis and arteriogenesis via vascular endothelial growth factor receptor-1- and neuropilin receptor-1-dependent mechanisms","volume":"119","author":"Rosenlew","year":"2009","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.atherosclerosis.2009.02.002","article-title":"Human C-reactive protein induces endothelial dysfunction and uncoupling of eNOS in vivo","volume":"206","author":"Hein","year":"2009","journal-title":"Atherosclerosis"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"514","DOI":"10.4328\/ACAM.22216","article-title":"The association between systemic inflammatory indices and prognosis in acute coronary syndrome","volume":"15","author":"Eyiol","year":"2024","journal-title":"Ann. Clin. Anal. Med."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Eyiol, A., Eyiol, H., Yilmaz, A., and Sari, H. (2026). Pan-Immune-Inflammatory Value (PIV) and HALP Score as Independent Prognostic Indicators in Acute Coronary Syndrome Patients. J. Clin. Med., 15.","DOI":"10.3390\/jcm15041660"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.atherosclerosis.2008.05.024","article-title":"Remnant-like particles accelerate endothelial progenitor cells senescence and induce cellular dysfunction via an oxidative mechanism","volume":"202","author":"Liu","year":"2009","journal-title":"Atherosclerosis"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/j.jjcc.2019.08.006","article-title":"Improvement of endothelial dysfunction is mediated through reduction of remnant lipoprotein after statin therapy in patients with coronary artery disease","volume":"75","author":"Nakamura","year":"2020","journal-title":"J. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7352\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:39:02Z","timestamp":1790077142000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/19\/7352"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,22]]},"references-count":33,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["jcm15197352"],"URL":"https:\/\/doi.org\/10.3390\/jcm15197352","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,22]]}}}