A Clinical and Biomarker Scoring System to Predict the Presence of Obstructive Coronary Artery Disease.
J Am Coll Cardiol
; 69(9): 1147-1156, 2017 Mar 07.
Article
em En
| MEDLINE
| ID: mdl-28254177
ABSTRACT
BACKGROUND:
Noninvasive models to predict the presence of coronary artery disease (CAD) may help reduce the societal burden of CAD.OBJECTIVES:
From a prospective registry of patients referred for coronary angiography, the goal of this study was to develop a clinical and biomarker score to predict the presence of significant CAD.METHODS:
In a training cohort of 649 subjects, predictors of ≥70% stenosis in at least 1 major coronary vessel were identified from >200 candidate variables, including 109 biomarkers. The final model was then validated in a separate cohort (n = 278).RESULTS:
The scoring system consisted of clinical variables (male sex and previous percutaneous coronary intervention) and 4 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 with no previous CAD (OR 8.67; p < 0.001). In the validation cohort, the score had an 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 into 5 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:
We described a clinical and biomarker score with high accuracy for predicting the presence of anatomically significant CAD. (The CASABLANCA Study Catheter Sampled Blood Archive in Cardiovascular Diseases; NCT00842868).Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doença da Artéria Coronariana
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Estenose Coronária
Tipo de estudo:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article