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Multiple Biomarkers to Predict Major Adverse Cardiovascular Events in Patients With Coronary Chronic Total Occlusions
Insights
A new blood biomarker panel effectively predicts cardiovascular events in patients with coronary chronic total occlusions (CTO). This tool aids in assessing long-term prognosis for CTO patients, improving risk stratification and patient care.
Area of Science:
- Cardiology
- Biomarker Discovery
- Prognostic Medicine
Background:
- Predicting long-term prognosis for patients with coronary chronic total occlusions (CTO) remains challenging due to limited tools.
- Cardiovascular (CV) events pose a significant risk to individuals with CTO.
Approach:
- The CASABLANCA study evaluated a panel of four blood biomarkers (kidney injury molecule-1, N-terminal pro-B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) in 241 patients with CTO.
- Baseline biomarker levels were categorized into low-, moderate-, and high-risk groups to assess their predictive performance for major adverse CV events (MACE) and CV death/heart failure (HF) hospitalization over a 4-year follow-up period.
Key Points:
- The biomarker panel demonstrated strong predictive performance, with C-statistics of 0.79 for MACE and 0.84 for CV death/HF hospitalization.
- Patients in the moderate- and high-risk groups showed significantly elevated hazard ratios for MACE (6.65 and 12.4, respectively) and CV death/HF hospitalization (5.61 and 15.6, respectively) compared to the low-risk group (all P <0.001).
- The study identified a substantial number of MACE (27.8%) and CV death/HF hospitalizations (23.2%) within the 4-year follow-up period.
Conclusions:
- A multi-biomarker panel can effectively aid in evaluating the risk of adverse outcomes in patients with coronary CTO.
- These findings have potential implications for refining patient management strategies and enriching clinical trials for CTO populations.
Background:
There are limited tools available to predict the long-term prognosis of persons with coronary chronic total occlusions (CTO).
Objectives:
We evaluated performance of a blood biomarker panel to predict cardiovascular (CV) events in patients with CTO.
Methods:
From 1251 patients in the CASABLANCA study, 241 participants with a CTO were followed for an average of 4 years for occurrence of major adverse CV events (MACE, CV death, non-fatal myocardial infarction or stroke) and CV death/heart failure (HF) hospitalization. Results of a biomarker panel (kidney injury molecule-1, N-terminal pro-B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) from baseline samples were expressed as low-, moderate-, and high-risk.
Results:
By 4 years, a total of 67 (27.8%) MACE events and 56 (23.2%) CV death/HF hospitalization events occurred. The C-statistic of the panel for MACE through 4 years was 0.79. Considering patients in the low-risk group as a reference, the hazard ratio of MACE by 4 years was 6.65 (95% confidence interval [CI]: 2.98-14.8) and 12.4 (95% CI:5.17-29.6) for the moderate and high-risk groups (both P <0.001). The C-statistic for CVD/HF hospitalization by 4 years was 0.84. Compared to the low-risk score group, the moderate and high-risk groups had hazard ratios of 5.61 (95% CI: 2.33-13.5) and 15.6 (95% CI: 6.18, 39.2; both P value <0.001).
Conclusion:
A multiple biomarker panel assists in evaluating the risk of adverse outcomes in patients with coronary CTO. These results may have implications for patient care and could have a role for clinical trial enrichment.
Clinical Trial:
CASABLANCA, ClinicalTrials.gov Identifier: NCT00842868.
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