Plasma infrared molecular fingerprinting (IMF) is able to stratify residual mortality risk in patients with coronary artery disease (CAD), outperforming guideline-recommended SMART2 scores and capturing clonal haematopoiesis of indeterminate potential (CHIP)-associated biology without the need for genomic sequencing, according to a recent study published in EHJ.

Moritz von Scheidt, MD, et al., included 1,341 patients (mean age 73 years, 24% women) with CAD confirmed by angiography. They measured plasma IMF spectra, comprehensive clinical data and targeted sequencing of 13 CHIP driver genes and followed the patients for 10.7 years. Plasma IMF performance was compared to the guideline-recommended SMART2 score.

The authors found that the IMF+Age model showed superior mortality discrimination when compared to SMART2 (C-index 0.79 vs. 0.74, p<0.01) as well as significant reclassification improvement. Among the IMF-derived strata, mortality increased from 3% in the low-risk category to 27% in the high-risk category.

Progressive enrichment of CHIP carriers was observed among derived risk strata, particularly spliceosome mutations, and external validation was performed in three independent cohorts, which produced similar results.

"IMF requires microlitre-scale plasma, minimal preparation and yields results within minutes on an automated platform, enabling same-visit risk assessment," note the authors. "In clinical workflows, IMF+Age could identify high-risk patients for intensified surveillance, optimization of guideline-directed therapy or enrollment in biology-guided trials."