Morten Krogh Christiansen1,2, Simon Winther3, Louise Nissen4, Bjarni Jóhann Vilhjálmsson5, Lars Frost6, Jane Kirk Johansen6, Peter Loof Møller7, Samuel Emil Schmidt8, Jelmer Westra1, Niels Ramsing Holm1, Henrik Kjærulf Jensen1,9, Evald Høj Christiansen1, Daníel Fannar Guðbjartsson10, Hilma Hólm10, Kári Stefánsson10, Hans Erik Bøtker1,9, Morten Bøttcher3, Mette Nyegaard11,7,8. 1. Department of Cardiology (M.K.C., J.W., N.R.H., H.K.J., E.H.C., H.E.B.), Aarhus University Hospital, Denmark. 2. Department of Internal Medicine, Horsens Regional Hospital, Denmark (M.K.C.). 3. Department of Cardiology (S.W., M.B.), Hospital Unit West, Herning, Denmark. 4. Department of Radiology (L.N.), Hospital Unit West, Herning, Denmark. 5. The National Centre for Register-Based Research (B.J.V.). 6. Department of Cardiology, Silkeborg Regional Hospital, Denmark (L.F., J.K.J.). 7. Department of Biomedicine (P.L.M., M.N.), Aarhus University, Denmark. 8. Department of Health Science and Technology, Aalborg University, Denmark (S.E.S., M.N.). 9. Department of Clinical Medicine, Faculty of Health (H.K.J., H.E.B.), Aarhus University, Denmark. 10. deCODE Genetics/Amgen, Inc, Reykjavik, Iceland (D.F.G., H.H., K.S.). 11. Department of Clinical Genetics (M.N.), Aarhus University Hospital, Denmark.
Abstract
BACKGROUND: Polygenic risk scores (PRSs) are associated with coronary artery disease (CAD), but the clinical potential of using PRSs at the single-patient level for risk stratification has yet to be established. We investigated whether adding a PRS to clinical risk factors (CRFs) improves risk stratification in patients referred to coronary computed tomography angiography on a suspicion of obstructive CAD. METHODS: In this prespecified diagnostic substudy of the Dan-NICAD trial (Danish study of Non-Invasive testing in Coronary Artery Disease), we included 1617 consecutive patients with stable chest symptoms and no history of CAD referred for coronary computed tomography angiography. CRFs used for risk stratification were age, sex, symptoms, prior or active smoking, antihypertensive treatment, lipid-lowering treatment, and diabetes. In addition, patients were genotyped, and their PRSs were calculated. All patients underwent coronary computed tomography angiography. Patients with a suspected ≥50% stenosis also underwent invasive coronary angiography with fractional flow reserve. A combined end point of obstructive CAD was defined as a visual invasive coronary angiography stenosis >90%, fractional flow reserve <0.80, or a quantitative coronary analysis stenosis >50% if fractional flow reserve measurements were not feasible. RESULTS: The PRS was associated with obstructive CAD independent of CRFs (adjusted odds ratio, 1.8 [95% CI, 1.5-2.2] per SD). The PRS had an area under the curve of 0.63 (0.59-0.68), which was similar to that for age and sex. Combining the PRS with CRFs led to a CRF+PRS model with area under the curve of 0.75 (0.71-0.79), which was 0.04 more than the CRF model (P=0.0029). By using pretest probability (pretest probability) cutoffs at 5% and 15%, a net reclassification improvement of 15.8% (P=3.1×10-4) was obtained, with a down-classification of risk in 24% of patients (211 of 862) in whom the pretest probability was 5% to 15% based on CRFs alone. CONCLUSIONS: Adding a PRS improved risk stratification of obstructive CAD beyond CRFs, suggesting a modest clinical potential of using PRSs to guide diagnostic testing in the contemporary clinical setting. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02264717.
BACKGROUND: Polygenic risk scores (PRSs) are associated with coronary artery disease (CAD), but the clinical potential of using PRSs at the single-patient level for risk stratification has yet to be established. We investigated whether adding a PRS to clinical risk factors (CRFs) improves risk stratification in patients referred to coronary computed tomography angiography on a suspicion of obstructive CAD. METHODS: In this prespecified diagnostic substudy of the Dan-NICAD trial (Danish study of Non-Invasive testing in Coronary Artery Disease), we included 1617 consecutive patients with stable chest symptoms and no history of CAD referred for coronary computed tomography angiography. CRFs used for risk stratification were age, sex, symptoms, prior or active smoking, antihypertensive treatment, lipid-lowering treatment, and diabetes. In addition, patients were genotyped, and their PRSs were calculated. All patients underwent coronary computed tomography angiography. Patients with a suspected ≥50% stenosis also underwent invasive coronary angiography with fractional flow reserve. A combined end point of obstructive CAD was defined as a visual invasive coronary angiography stenosis >90%, fractional flow reserve <0.80, or a quantitative coronary analysis stenosis >50% if fractional flow reserve measurements were not feasible. RESULTS: The PRS was associated with obstructive CAD independent of CRFs (adjusted odds ratio, 1.8 [95% CI, 1.5-2.2] per SD). The PRS had an area under the curve of 0.63 (0.59-0.68), which was similar to that for age and sex. Combining the PRS with CRFs led to a CRF+PRS model with area under the curve of 0.75 (0.71-0.79), which was 0.04 more than the CRF model (P=0.0029). By using pretest probability (pretest probability) cutoffs at 5% and 15%, a net reclassification improvement of 15.8% (P=3.1×10-4) was obtained, with a down-classification of risk in 24% of patients (211 of 862) in whom the pretest probability was 5% to 15% based on CRFs alone. CONCLUSIONS: Adding a PRS improved risk stratification of obstructive CAD beyond CRFs, suggesting a modest clinical potential of using PRSs to guide diagnostic testing in the contemporary clinical setting. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02264717.
Authors: Jonathan D Newman; Pamela S Douglas; Ilya Zhbannikov; Maros Ferencik; Borek Foldyna; Udo Hoffmann; Svati H Shah; Geoffrey S Ginsburg; Michael T Lu; Deepak Voora Journal: Am Heart J Date: 2022-05-21 Impact factor: 5.099