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.

Clinical Topics: Acute Coronary Syndromes, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, ACS and Cardiac Biomarkers, Lipid Metabolism, Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Acute Kidney Injury, Adiponectin, Apolipoprotein C-I, Biological Markers, Coronary Artery Disease, Coronary Angiography, Coronary Stenosis, Cytokines, Myocardial Infarction, Myocardial Ischemia, Percutaneous Coronary Intervention, Predictive Value of Tests, Primary Prevention


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