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Biomarker Prediction of Complex Coronary Revascularization Procedures in the FOURIER Trial
Antonio Fagundes1, David A Morrow2, Kazuma Oyama3
1IDOR -D'Or Institute for Research and Education, Sao Paolo, Brazil; Thrombolysis in Myocardial Infarction (TIMI) Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Elevated cardiovascular biomarkers predict major adverse cardiovascular events and complex revascularization procedures. A multimarker score effectively identifies patients with high-risk coronary anatomy, aiding risk stratification.
Area of Science:
- Cardiovascular Medicine
- Biomarker Research
- Interventional Cardiology
Background:
- Cardiovascular biomarkers are established predictors of major adverse cardiovascular events (MCE).
- The association between biomarkers and complex coronary revascularization or high-risk coronary anatomy remains unclear.
Purpose of the Study:
- To investigate the relationship between baseline biomarkers and MCE.
- To assess the association of biomarkers with complex revascularization procedures and coronary anatomy.
Main Methods:
- Analysis of the FOURIER trial data (n=27,564) involving patients with stable atherosclerosis.
- Utilized a multimarker score based on elevated high-sensitivity C-reactive protein, NT-proBNP, high-sensitivity troponin I, and GDF-15.
- Examined associations with MCE, complex revascularization (CABG or complex PCI), and coronary anatomy.
Main Results:
- A graded association was observed between the multimarker score and increased risk of MCE (HRadj: 2.90 for high score).
- Higher biomarker scores correlated with increased risk of complex revascularization (HRadj: 2.07 for high score).
- Elevated biomarker counts predicted left main disease, multivessel disease, and chronic total occlusion.
Conclusions:
- A biomarker-based strategy can identify stable patients at risk for coronary events and complex procedures.
- This approach predicts high-risk coronary anatomy, offering valuable insights into cardiovascular risk.
- Findings enhance understanding of biomarker associations with coronary anatomical complexity and clinical events.
Background:
Biomarkers are known to predict major adverse cardiovascular events. However, the association of biomarkers with complex coronary revascularization procedures or high-risk coronary anatomy at the time of revascularization is not understood.
Objectives:
We examined the associations between baseline biomarkers and major coronary events (MCE) and complex revascularization procedures.
Methods:
FOURIER was a randomized trial of the proprotein convertase subtilisin-kexin type 9 inhibitor evolocumab vs placebo in 27,564 patients with stable atherosclerosis. We analyzed adjusted associations among the biomarkers, MCE (coronary death, myocardial infarction, or revascularization), and complex revascularization (coronary artery bypass graft or complex percutaneous coronary intervention) using a multimarker score with 1 point assigned for each elevated biomarker (high-sensitivity C-reactive protein ≥2 mg/L; N-terminal pro-B-type natriuretic peptide ≥450 pg/mL; high-sensitivity troponin I ≥6 ng/L; growth-differentiation factor-15 ≥1,800 pg/mL).
Results:
When patients were grouped by the number of elevated biomarkers (0 biomarkers, n = 6,444; 1-2 biomarkers, n = 12,439; ≥3 biomarkers, n = 2,761), there was a significant graded association between biomarker score and the risk of MCE (intermediate score: HRadj: 1.57 [95% CI: 1.38-1.78]; high score: HRadj: 2.90 [95% CI: 2.47-3.40]), and for complex revascularization (intermediate: HRadj: 1.33 [95% CI: 1.06-1.67]; high score: HRadj: 2.07 [95% CI: 1.52-2.83]) and its components (Ptrend <0.05 for each). The number of elevated biomarkers also correlated with the presence of left main disease, multivessel disease, or chronic total occlusion at the time of revascularization (P < 0.05 for each).
Conclusions:
A biomarker-based strategy identifies stable patients at risk for coronary events, including coronary artery bypass graft surgery and complex percutaneous coronary intervention, and predicts high-risk coronary anatomy at the time of revascularization. These findings provide insight into the relationships between cardiovascular biomarkers, coronary anatomical complexity, and incident clinical events. (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk [FOURIER]; NCT01764633).
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