Silent Predictors of Chronic Total Occlusion in Patients with Stable Angina Pectoris: The Role of Inflammatory and Metabolic Biomarkers

Introduction: Atherosclerosis and inflammation play central roles in the pathogenesis of coronary artery disease (CAD). Early identification of chronic total occlusion (CTO) in patients presenting with stable angina pectoris is clinically important for guiding treatment strategies. Therefore, evaluating the diagnostic utility of novel inflammatory and metabolic biomarkers has gained increasing relevance. This study aimed to assess the predictive value of the systemic inflammatory index (SII), uric acid/HDL ratio (UHR), monocyte/HDL ratio (MHR), and triglyceride–glucose (TyG) index for detecting the presence of CTO.Materials and Methods: In this retrospective study, 96 patients who underwent coronary angiography between January 1, 2024 and April 1, 2025 at Mersin City Training and Research Hospital were included. Thirty-six patients with at least one coronary artery showing 100% occlusion constituted the CTO group, while 60 patients without CTO formed the control group. Demographic characteristics and laboratory parameters were recorded, and SII, UHR, MHR, and TyG values were calculated and compared between groups.Results: There were no significant differences between the groups regarding SII (p = 0.118), UHR (p = 0.887), or TyG (p = 0.333). However, MHR levels were significantly higher in the CTO group (p < 0.001). ROC analysis identified an MHR cutoff value of > 8.7 as a meaningful threshold for predicting CTO.Discussion: Among the biomarkers evaluated, only MHR demonstrated a significant association with the presence of CTO. Reflecting increased monocyte activity and reduced anti-inflammatory HDL capacity, MHR appears consistent with the chronic inflammatory nature of CTO. Its simplicity, low cost, and availability from routine laboratory tests further support MHR as a practical biomarker for assessing CTO risk in clinical practice.