Nasrien E Ibrahim1, James L Januzzi2, Craig A Magaret3, Hanna K Gaggin4, Rhonda F Rhyne3, Parul U Gandhi5, Noreen Kelly6, Mandy L Simon1, Shweta R Motiwala6, Arianna M Belcher1, Roland R J van Kimmenade7. 1. Massachusetts General Hospital, Division of Cardiology, Boston, Massachusetts. 2. Massachusetts General Hospital, Division of Cardiology, Boston, Massachusetts; Harvard Clinical Research Institute, Cardiometabolic Trials, Boston, Massachusetts. Electronic address: jjanuzzi@partners.org. 3. Prevencio, Inc., Kirkland, Washington. 4. Massachusetts General Hospital, Division of Cardiology, Boston, Massachusetts; Harvard Clinical Research Institute, Cardiometabolic Trials, Boston, Massachusetts. 5. Yale University, Cardiology, New Haven, Connecticut. 6. Brigham and Women's Hospital, Cardiology, Boston, Massachusetts. 7. Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands.
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).
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).
Authors: Pradeep Natarajan; Tim S Collier; Zhicheng Jin; Asya Lyass; Yiwei Li; Nasrien E Ibrahim; Renata Mukai; Cian P McCarthy; Joseph M Massaro; Ralph B D'Agostino; Hanna K Gaggin; Cory Bystrom; Marc S Penn; James L Januzzi Journal: J Am Coll Cardiol Date: 2019-05-07 Impact factor: 24.094
Authors: Cian P McCarthy; Nasrien E Ibrahim; Roland R J van Kimmenade; Hanna K Gaggin; Mandy L Simon; Parul Gandhi; Noreen Kelly; Shweta R Motiwala; Renata Mukai; Craig A Magaret; Grady Barnes; Rhonda F Rhyne; Joseph M Garasic; James L Januzzi Journal: Clin Cardiol Date: 2018-06-14 Impact factor: 2.882
Authors: Wilson R Freitas; Luis Vicente Franco Oliveira; Eduardo A Perez; Elias J Ilias; Carina P Lottenberg; Anderson S Silva; Jessica J Urbano; Manoel C Oliveira; Rodolfo P Vieira; Marcelo Ribeiro-Alves; Vera L S Alves; Paulo Kassab; Fabio R Thuler; Carlos A Malheiros Journal: Obes Surg Date: 2018-07 Impact factor: 4.129
Authors: Cian P McCarthy; Shreya Shrestha; Nasrien Ibrahim; Roland R J van Kimmenade; Hanna K Gaggin; Renata Mukai; Craig Magaret; Grady Barnes; Rhonda Rhyne; Joseph M Garasic; James L Januzzi Journal: Open Heart Date: 2019-05-13
Authors: Sammy Elmariah; Cian McCarthy; Nasrien Ibrahim; Deborah Furman; Renata Mukai; Craig Magaret; Rhonda Rhyne; Grady Barnes; Roland R J van Kimmenade; James L Januzzi Journal: Open Heart Date: 2018-11-01