A Clinical and Biomarker Scoring System to Predict the Presence of Obstructive Coronary Artery Disease
Publication year
2017Source
Journal of the American College of Cardiology, 69, 9, (2017), pp. 1147-1156ISSN
Publication type
Article / Letter to editor
Display more detailsDisplay less details
Organization
Cardiology
Journal title
Journal of the American College of Cardiology
Volume
vol. 69
Issue
iss. 9
Page start
p. 1147
Page end
p. 1156
Subject
Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health Sciences; Cardiology Radboud University Medical CenterAbstract
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).
This item appears in the following Collection(s)
- Academic publications [245054]
- Faculty of Medical Sciences [93209]
Upload full text
Use your RU credentials (u/z-number and password) to log in with SURFconext to upload a file for processing by the repository team.