JCCVS
Journal of Cardiology & Cardiovascular Surgery

Journal of Cardiology & Cardiovascular Surgery scientific, open-access, double-blind peer-reviewed journal covering a wide spectrum of topics in cardiology and cardiovascular surgery.

eISSN: 2980-1397
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
The HALP Score as a novel predictor of coronary collateral circulation in patients with chronic total occlusion: a retrospective, single-center study
Abstract
Aims: The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score is a composite index reflecting inflammatory, nutritional, and hematological status. While it has prognostic value in cardiovascular diseases, its relationship with the development of coronary collateral circulation (CCC) in patients with chronic total occlusion (CTO) remains unclear. This study aimed to investigate the association between the HALP score and the extent of CCC and to determine its predictive value for poor collateral development in patients with stable CAD and CTO.
Methods: A total of 241 consecutive patients with stable CAD and at least one CTO were retrospectively included. Participants were categorized into good (Rentrop grades 2-3, n=123) and poor CCC (Rentrop grades 0-1, n=118) groups based on blinded angiographic assessment. The HALP score was calculated from admission blood samples. Independent predictors were identified using multivariate logistic regression, and predictive performance was assessed by receiver operating characteristic (ROC) curve analysis.
Results: Patients with good CCC had a significantly higher HALP score than those with poor CCC (p=0.007). The HALP score showed a strong positive correlation with the Rentrop grade (r=0.69, p=0.034). Multivariate analysis confirmed that a lower HALP score was an independent predictor of poor collateral development (OR=0.822, 95% CI: 0.618-0.992, p=0.026), alongside other markers like NLR and NPAR. The ROC analysis demonstrated that a HALP score ?31.2 predicted poor CCC with 78% sensitivity and 82% specificity (AUC=0.822, 95% CI: 0.760-0.878, p=0.024).
Conclusion: The HALP score is a powerful and independent predictor of well-developed coronary collaterals in patients with stable CAD and CTO. Derived from routine blood tests, it serves as an integrative biomarker for risk stratification, potentially identifying patients who may benefit from more aggressive management strategies.

Keywords : HALP score, chronic total occlusion, coronary collateral circulation

Download Article


1. Schirmer SH, Van Nooijen FC, Piek JJ, Van Royen N. Stimulation of collateral artery growth: travelling further down the road to clinical application. Heart. 2009;95(3):191-197. doi:10.1136/hrt.2007.136119
2. Seiler C, Stoller M, Pitt B, Meier P. The human coronary collateral circulation: development and clinical importance. Eur Heart J. 2013; 34(34):2674-2682. doi:10.1093/eurheartj/eht195
3. Adali MK, Buber I, Sen G, Yilmaz S. Relationship between Systemic Immune-Inflammation Index and coronary collateral circulation in patients with chronic total occlusion. Arq Bras Cardiol. 2022;119(1):69-75. doi:10.36660/abc.20210414
4. Bhatt H, Kochar S, Htun WW, Julliard K, Fernaine G. Coronary collateral circulation and cardiovascular risk factors. Angiology. 2015; 66(6):588-594. doi:10.1177/0003319714545342
5. van der Hoeven NW, Teunissen PF, Werner GS, et al. Clinical parameters associated with collateral development in patients with chronic total coronary occlusion. Heart. 2013;99(15):1100-1105. doi:10. 1136/heartjnl-2013-304006
6. Gulec S, Ozdemir AO, Maradit-Kremers H, Dincer I, Atmaca Y, Erol C. Elevated levels of C-reactive protein are associated with impaired coronary collateral development. Eur J Clin Invest. 2006;36(6):369-375. doi:10.1111/j.1365-2362.2006.01641.x
7. Uysal OK, Turkoglu C, Sahin DY, et al. The relationship between neutrophil-to-lymphocyte ratio and coronary collateral circulation. Clinical and Applied Thrombosis/Hemostasis. 2015;21(4):329-333. doi: 10.1177/1076029613503399
8. Aktaş İ. 6. neutrophil percentage-to-albumin ratio as a predictor of collateral circulation in chronic total occlusion. Anatolian J Cardiol. 2025. doi:10.14744/anatoljcardiol.2025.4987
9. Antar R, Farag C, Xu V, Drouaud A, Gordon O, Whalen MJ. Evaluating the baseline hemoglobin, albumin, lymphocyte, and platelet (HALP) score in the United States adult population and comorbidities: an analysis of the NHANES. Front Nutr. 2023;10:1206958. doi:10.3389/fnut.2023.1206958
10. Pan H, Lin S. Association of hemoglobin, albumin, lymphocyte, and platelet score with risk of cerebrovascular, cardiovascular, and all-cause mortality in the general population: results from the NHANES 1999-2018. Front Endocrinol (Lausanne). 2023;14:1173399. doi:10.3389/fendo. 2023.1173399
11. Cao Z, Chen N, Jiang H, et al. Association between the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and adverse outcomes in critically ill patients with acute myocardial infarction: a retrospective study and machine learning analysis. Rev Cardiovasc Med. 2025;26(8). doi:10.31083/RCM43942
12. Yilmaz R, Toprak K, Yilmaz M, Karagoz A, Öz E. Investigation of the usefulness of HALP score in predicting short-term mortality in patients with acute decompensated heart failure in a coronary care unit. Medicina (Lithuania). 2024;60(9):1385. doi:10.3390/medicina60091385
13. Liu Y, Wang Y, Meng Y, Wang Q, Guo Y. Correlation between the hemoglobin, albumin, lymphocyte, and platelet (HALP) score and left ventricular hypertrophy in older patients with hypertension. Cardiovasc Innov Appl. 2023;8(1):946. doi:10.15212/CVIA.2023.0068
14. Xin Y, Wang Y, Shu Y, Liang H, Yang Y. Hemoglobin, albumin, lymphocyte, and platelet (HALP) score predict prognosis in patients with atrial fibrillation and acute coronary syndrome or undergoing percutaneous coronary intervention. BMC Cardiovasc Disord. 2025; 25(1):507. doi:10.1186/s12872-025-04968-2
15. Kiliç R, Güzel T, Aktan A, Güzel H, Kaya AF, Çankaya Y. The effectiveness of HALP score in predicting mortality in non-ST-elevation myocardial infarction patients. Coron Artery Dis. 2025;36(1):39-44. doi: 10.1097/MCA.0000000000001415
16. Pannu AK. Expanding risk stratification in acute coronary syndromes with systemic indices: HALP and CALLY. Biomark Med.Taylor and Francis Ltd. 2025;19(12):451-453. doi:10.1080/17520363.2025.2517525
17. Cohen M, Peter Rentrop K, Limitation of myocardial ischemia by collateral circulation during sudden controlled coronary artery occlusion in human subjects: a prospective study. Circulation. 1986; 74(3):469-476. doi:10.1161/01.cir.74.3.469
18. Chen XL, Xue L, Wang W, et al. Prognostic significance of the combination of preoperative hemoglobin, albumin, lymphocyte and platelet in patients with gastric carcinoma: a retrospective cohort study. Oncotarget. 2015;38(6):41370-41382. doi:10.18632/oncotarget.5629
19. Uysal OK, Turkoglu C, Sahin DY, et al. The relationship between neutrophil-to-lymphocyte ratio and coronary collateral circulation. Clinical and Applied Thrombosis/Hemostasis. 2015;21(4):329-333. doi: 10.1177/1076029613503399
20. Akdag S, Akyol A, Asker M, Ozturk F, Gumrukcuoglu HA. The relation of platelet-lymphocyte ratio and coronary collateral circulation in patients with non-ST segment elevation myocardial infarction. Postepy w Kardiologii Interwencyjnej. 2016;12(3):224-230. doi:10.5114/aic.2016. 61644
21. van der Laan AM, Piek JJ, van Royen N. Targeting angiogenesis to restore the microcirculation after reperfused MI. Nat Rev Cardiol. 2009;6(8):515-523. doi:10.1038/nrcardio.2009.103
22. Anand IS, Chandrashekhar Y, Wander GS, Chawla LS. Endothelium-derived relaxing factor is important in mediating the high output state in chronic severe anemia. J Am Coll Cardiol. 1995;25(6):1402-1407. doi: 10.1016/0735-1097(95)00007-Q
23. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. J Parenteral Enteral Nutrition.John Wiley and Sons Inc. 2019;43(2):181-193. doi:10.1002/jpen.1451
24. Nelson JJ, Liao D, Sharrett AR, et al. Serum albumin level as a predictor of incident coronary heart disease: the atherosclerosis risk in communities (ARIC) study. Am J Epidemiol. 2000;151(5):468-477. doi: 10.1093/oxfordjournals.aje.a010232
25. Núñez J, Núñez E, Bodí V, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol. 2008;101(6):747-752. doi: 10.1016/j.amjcard.2007.11.004
26. Van Weel V, Toes REM, Seghers L, et al. Natural killer cells and CD4+ T-cells modulate collateral artery development. Arterioscler Thromb Vasc Biol. 2007;27(11):2310-2318. doi:10.1161/ATVBAHA.107.151407
27. Davì G, Patrono C. Platelet activation and atherothrombosis.N Engl J Med. 2007;357(24):2482-2494. doi:10.1056/NEJMra071014
28. Li Q, Chen M, Zhao H, Zeng J. The prognostic and clinicopathological value of HALP score in non-small cell lung cancer. Front Immunol. 2025;16:1576326. doi:10.3389/fimmu.2025.1576326
29. Demir O, Demirag G, Cakmak F, Bayraktar DI, Tokmak L. Hemoglobin, albumin, lymphocytes and platelets (HALP) score as a predictor of survival in patients with glioblastoma (GBM). BMC Neurol. 2024;24(1):260. doi:10.1186/s12883-024-03639-7
30. Xu H, Zheng X, Ai J, Yang L. Hemoglobin, albumin, lymphocyte, and platelet (HALP) score and cancer prognosis: a systematic review and meta-analysis of 13,110 patients. Int Immunopharmacol. 2023;114: 109496. doi:10.1016/J.INTIMP.2022.109496
Article available in :
Volume 3, Issue 4, 2025
Page : 76-81
https://doi.org/10.51271/JCCVS-0064
Article Information
Received : 18 Kas 2025
Accepted : 07 Ara 2025
Published : 23 Ara 2025
Corresponding Author :

Görkem Yıldız: Department of Cardiology, Faculty of Medicine, Yüksek İhtisas University, Ankara, Turkiye

[email protected]
Citation : Yıldız G. The HALP score as a novel predictor of coronary collateral circulation in patients with chronic total occlusion: a retrospective, single-center study. J Cardiol Cardiovasc Surg. 2025;3(4):76-81.

Read: 64
Download : 54
Cited: 0
_Footer