Biomarker Score to Predict Presence of Obstructive CAD

Study Questions:

What is the predictive ability of a clinical and biomarker score for the presence of significant coronary artery disease (CAD)?

Methods:

In a training cohort of 649 subjects, predictors of ≥70% stenosis in at least one major coronary vessel were identified from more than 200 candidates, including 109 biomarkers. The final model was then validated in a separate cohort (n = 278). Multivariable logistic regression evaluated the performance of the model in the training set as a whole as well as in several relevant subgroups.

Results:

The scoring system consisted of clinical variables (male sex, prior percutaneous coronary intervention) and four biomarkers (midkine, adiponectin, apolipoprotein C-I, and kidney injury molecule-1). In the training cohort, elevated scores were predictive of ≥70% stenosis in all subjects (odds ratio [OR], 9.74; p < 0.001), men (OR, 7.88; p < 0.001), women (OR, 24.8; p < 0.001), and those without prior CAD (OR, 8.67; p < 0.001). In the validation cohort, the score had area under the receiver operating characteristic curve of 0.87 (p < 0.001) for coronary stenosis ≥70%. Higher scores were associated with greater severity of angiographic stenosis. At optimal cutoff, the score had 77% sensitivity, 84% specificity, and a positive predictive value of 90% for ≥70% stenosis. Partitioning the score in five levels allowed for identifying or excluding CAD with >90% predictive value in 42% of subjects. An elevated score predicted incident acute myocardial infarction during 3.6 years of follow-up (hazard ratio, 2.39; p < 0.001).

Conclusions:

The authors concluded that they have developed a clinical and biomarker score with high accuracy for predicting presence of anatomically significant CAD.

Perspective:

This study reports a scoring strategy to reliably diagnose severe epicardial CAD with combined clinical variables and concentrations of four relevant biomarkers. While this score appears to predict the presence of ≥70% angiographic coronary stenosis with high sensitivity and specificity, additional studies are indicated to validate this score in a broader and larger population of patients, and further define its role in the selection of patients for additional noninvasive or invasive testing.


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