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Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After
Andrej Teren1,2, Jeffrey Netto2,3,4, Joachim Thiery2,4,5
1Department of Cardiology and Intensive Care Medicine Bielefeld University, Klinikum Bielefeld Mitte Bielefeld Germany.
Insights
High-sensitivity troponin T (hsTnT) aids chronic coronary syndrome diagnosis, while NT-proBNP predicts mortality and identifies patients benefiting from revascularization. These biomarkers refine risk stratification and treatment decisions in cardiology.
Area of Science:
- Cardiology
- Biomarker Research
- Clinical Diagnostics
Background:
- The roles of cardiovascular biomarkers in chronic coronary syndrome (CCS) diagnosis and prognosis are not fully understood.
- Accurate risk stratification is crucial for managing CCS patients.
Purpose of the Study:
- To evaluate the diagnostic and prognostic utility of several cardiovascular biomarkers in patients with suspected CCS.
- To determine if these biomarkers can refine risk assessment and guide treatment decisions, particularly revascularization.
Main Methods:
- Prospective enrollment of 2251 patients undergoing coronary angiography for suspected CCS.
- Measurement of high-sensitivity troponin T (hsTnT), NT-proBNP, hs-CRP, IL-6, and copeptin.
- Analysis using ROC curves and Cox regression with interaction testing for biomarker and treatment effects.
Main Results:
- HsTnT demonstrated diagnostic capacity, with incremental value varying by clinical risk.
- NT-proBNP was a strong mortality predictor across all treatment strategies (optimal medical therapy, PCI, CABG).
- A 150 pg/mL NT-proBNP threshold identified high-risk patients who significantly benefited from revascularization, showing a 40% mortality reduction.
Conclusions:
- HsTnT offers incremental diagnostic value in CCS, tailored to clinical risk categories.
- NT-proBNP serves as a universal prognostic marker, identifying patients with differential mortality risk and distinct benefits from revascularization.
Background:
The diagnostic and prognostic roles of cardiovascular biomarkers in chronic coronary syndrome remain unclear.
Methods:
Patients undergoing coronary angiography for suspected chronic coronary syndrome were prospectively enrolled (n=2251; median follow-up 12.6 years). Obstructive coronary artery disease was defined as ≥50% stenosis in ≥1 major epicardial vessel. HsTnT (high-sensitivity cardiac troponin T), NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity C-reactive protein, interleukin-6, and copeptin were measured. Receiver operating characteristic analysis and Cox regression with biomarker × treatment interaction testing were performed.
Results:
Overall, 888 patients (39.4%) had obstructive coronary artery disease. Only hsTnT showed meaningful diagnostic capacity (area under the curve 0.669; risk factor-weighted clinical likelihood area under the curve 0.663), with incremental benefit inversely proportional to risk factor-weighted clinical likelihood category (Δ area under the curve: very low 10.4%, low 8.0%, intermediate/high 5.0%). NT-proBNP was the strongest mortality predictor across optimal medical therapy (hazard ratio [HR], 1.488 [95% CI, 1.288-1.720], P<0.001), percutaneous coronary intervention (HR, 1.220 [95% CI, 1.020-1.458], P=0.029), and coronary artery bypass grafting (HR, 1.220 [95% CI, 1.049-1.420], P=0.010). Interaction analysis validated a data-derived 150 pg/mL threshold (P=0.032): below it, mortality was comparably low regardless of revascularization (HR, 0.98 [95% CI, 0.67-1.43], P=0.910); above it, baseline risk was markedly elevated (HR, 5.75 [95% CI, 4.10-8.00], P<0.001) and revascularization associated with 40% mortality reduction, with substantial residual risk (HR, 3.43 [95% CI, 2.70-4.40], P<0.001).
Conclusions:
HsTnT provides risk factor-weighted clinical likelihood category-specific incremental diagnostic value. NT-proBNP is a universal prognostic marker identifying patients with distinct revascularization-associated mortality reduction driven by differential baseline risk.
Registration:
URL: https://clinicaltrials.gov/study/NCT00497887; Unique Identifier: NCT00497887.
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