Relation Between C-X-C Motif Chemokine Receptor 4 Levels and the Presence and Extent of Angiographic Coronary Collaterals in Patients With Chronic Total Coronary Occlusion

Coronary collateral circulation is an alternative source of blood supply to the myocardium in the presence of chronic total coronary occlusion (CTO). C-X-C motif chemokine receptor 4 (CXCR4) signaling usually contributes to neovascularization. Here, we investigate the relation between CXCR4 levels in peripheral blood CD34+ cells and the formation of angiographic coronary collaterals and determine the risk factors that affect CXCR4 expression in patients with CTO. Demographic, biochemical, and angiographic variables were collected from 324 patients with CTO and 90 negative controls. The presence and extent of collaterals were scored according to the Rentrop scoring system (Rentrop's). CXCR4 levels and plasma biochemical factors were detected. Clinical outcomes were collected during a 12-month follow-up. Results show that low (Rentrop's 0 or 1) and high (Rentrop's of 2 or 3) coronary collateralizations were detected in 183 and 141 patients, respectively. The Rentrop scores were positively correlated with CXCR4 levels in patients with CTO. Patients with low CXCR4 expression exhibited worse clinical outcomes compared with those with high CXCR4 expression. Univariate correlation analysis revealed that age of ≥65 years, women, diabetes, increased plasma level of high-sensitivity C-reactive protein (hs-CRP), and N-terminal brain-type natriuretic peptide were associated with low CXCR4 levels. In conclusion, CXCR4 levels were positively correlated with the presence and extent of angiographic coronary collaterals in patients with CTO. Elder age, women, diabetes, increased plasma level of high-sensitivity C-reactive protein, and N-terminal brain-type natriuretic peptide may be risk factors of CXCR4 expression.