An age- and sex-specific gene expression score is associated with revascularization and coronary artery disease: Insights from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial - 18/04/17
, Adrian Coles, PhD c, Kerry L. Lee, PhD c, Udo Hoffmann, MD, MPH d, James A. Wingrove, PhD e, Brian Rhees, PhD e, Lin Huang, PhD e, Susan E. Daniels, PhD e, Mark Monane, MD e, Steven Rosenberg, PhD e, Svati H. Shah, MD b, c, William E. Kraus, MD b, Geoffrey S. Ginsburg, MD, PhD a, b, Pamela S. Douglas, MD b, cAbstract |
Background |
Identifying predictors of coronary artery disease (CAD)-related procedures and events remains a priority.
Methods |
We measured an age- and sex-specific gene expression score (ASGES) previously validated to detect obstructive CAD (oCAD) in symptomatic nondiabetic patients in the PROMISE trial. The outcomes were oCAD (≥70% stenosis in ≥1 vessel or ≥50% left main stenosis on CT angiography [CTA]) and a composite endpoint of death, myocardial infarction, revascularization, or unstable angina.
Results |
The ASGES was determined in 2370 nondiabetic participants (47.5% male, median age 59.5 years, median follow-up 25 months), including 1137 with CTA data. An ASGES >15 was associated with oCAD (odds ratio 2.5 [95% CI 1.6-3.8], P<.001) and the composite endpoint (hazard ratio [HR] 2.6 [95% CI 1.8-3.9], P<.001) in unadjusted analyses. After adjustment for Framingham risk, an ASGES >15 remained associated with the composite endpoint (P=.02); the only component that was associated was revascularization (adjusted HR 2.69 [95% CI 1.52-4.79], P<.001). Compared to noninvasive testing, the ASGES improved prediction for the composite (increase in c-statistic=0.036; continuous net reclassification index=43.2%). Patients with an ASGES ≤15 had a composite endpoint rate no different from those with negative noninvasive test results (3.2% vs. 2.6%, P=.29).
Conclusions |
A blood-based genomic test for detecting oCAD significantly predicts near-term revascularization procedures, but not non-revascularization events. Larger studies will be needed to clarify the risk with non-revascularization events.
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| Todd D. Miller, MD served as guest editor for this article. |
Vol 184
P. 133-140 - février 2017 Retour au numéro
Article précédent
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