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Multiple Biomarkers to Predict Major Adverse Cardiovascular Events in Patients With Coronary Chronic Total Occlusions
Srikanth Adusumalli1, Cian P McCarthy1, Craig A Magaret2
1Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Insights
A new blood biomarker panel effectively predicts long-term cardiovascular risks in patients with coronary chronic total occlusions (CTO), aiding in better risk stratification and patient care.
Area of Science:
- Cardiology
- Biomarker Discovery
- Prognostics
Background:
- Predicting long-term prognosis in coronary chronic total occlusions (CTO) remains challenging.
- Existing tools for risk stratification in CTO patients are limited.
- Cardiovascular (CV) events pose a significant risk to individuals with CTO.
Purpose of the Study:
- To evaluate a previously described blood biomarker panel for predicting CV events in patients with CTO.
- To assess the panel's ability to discriminate risk for major adverse CV events (MACE) and CV death/heart failure (HF) hospitalization.
- To determine the clinical utility of this biomarker panel in CTO patient management.
Main Methods:
- A cohort of 241 patients with CTO from the CASABLANCA study was analyzed.
- Baseline blood samples were used to assess a panel of four biomarkers: kidney injury molecule-1, N-terminal pro-B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1.
- Patients were followed for an average of 4 years to record MACE and CV death/HF hospitalization events.
Main Results:
- The biomarker panel demonstrated strong predictive performance, with a C-statistic of 0.79 for MACE and 0.84 for CV death/HF hospitalization.
- Patients categorized as medium- and high-risk by the panel 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.
- A substantial proportion of patients experienced adverse events, with 27.8% having MACE and 23.2% experiencing CV death/HF hospitalization within 4 years.
Conclusions:
- A multi-biomarker panel effectively differentiates risk for adverse outcomes in patients with coronary CTO.
- These findings support the use of this panel for improved risk stratification and personalized patient care in CTO.
- The biomarker panel may also be valuable for enriching patient selection in clinical trials for CTO interventions.
Abstract:
There are limited tools available to predict the long-term prognosis of persons with coronary chronic total occlusions (CTO). A previously described blood biomarker panel to predict cardiovascular (CV) events was evaluated in patients with CTO. From 1,251 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, nonfatal 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-, medium-, and high-risk. By 4 years, a total of 67 (27.8%) MACE and 56 (23.2%) CV death/HF hospitalization events occurred. The C-statistic of the panel for MACE through 4 years was 0.79 (p < 0.001). Considering the low-risk group as referent, the hazard ratio (HR) of MACE by 4 years was 6.65 (95% confidence interval [CI]: 2.98 to 14.8) and 12.4 (95% CI:5.17 to 29.6) for the medium and high-risk groups (both p < 0.001). The C-statistic for CVD/HF hospitalization by 4 years was 0.84 (p < 0.001). Compared to the low-risk score group, the medium and high-risk groups had HR of 5.61 (95% CI: 2.33 to 13.5) and 15.6 (95% CI: 6.18, 39.2; both p value <0.001). In conclusion, a multiple biomarker panel assisted in discriminating a broad range of risk for adverse outcomes in patients with coronary CTO. These results may have implications for risk stratification, patient care and could have a role for clinical trial enrichment.
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