Beyond Lesion Complexity: Do We Need a New Score for Chronic Total Occlusions?

The Hemoglobin, Albumin, Lymphocyte, and Platelet (HALP) score is an index that combines readily available laboratory parameters and reflects an individual’s inflammatory and nutritional status. Traditionally used in oncologic and inflammatory diseases, it has recently emerged as a prognostic marker in various cardiovascular conditions, including acute coronary syndromes, heart failure, and non-valvular atrial fibrillation. Lower HALP values have been associated with a pro-inflammatory state, impaired hematologic homeostasis, and poorer nutritional status.

These factors may adversely affect vascular remodeling processes, leading to pathological angiogenesis. In this context, Akkaya and Öztürk retrospectively analyzed 269 patients with chronic total coronary occlusion identified by coronary angiography and demonstrated that the HALP score exhibited excellent discriminatory performance for the detection of well-developed collateral circulation. As reported in the current issue of the Arquivos Brasileiros de Cardiologia, the HALP score was significantly higher in patients with prominent collateral circulation compared with those with poorly developed collaterals (75.5 ± 13.9 vs. 35.1 ± 11.3; p < 0.001), and was an independent predictor of this angiographic finding (OR: 0.88; 95% CI: 0.83–0.93; p 49.08, yielding a sensitivity of 91.3% and a specificity of 90.8%. In a similar study, Süleymanoğlu et al. retrospectively evaluated 240 patients with chronic total coronary occlusion and confirmed that the HALP score was positively associated with collateral circulation quality, as assessed by the Werner classification, remaining a strong independent predictor in multivariable analysis.

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