Key result
Novel MMP-9, TIMP-2, and Apo-CIII panel identifies severe CAD with ~0.99 AUC.
Why the study?
MMPs, TIMPs, and apolipoproteins are implicated in plaque instability and cardiovascular risk, but the optimal blood biomarker panel to evaluate CAD severity was not established.
Does a biomarker panel including MMPs, TIMPs, and apolipoproteins accurately predict the severity of coronary artery disease?
Case-Control (n=757)
Yes
Does a biomarker panel including MMPs, TIMPs, and apolipoproteins accurately predict the severity of coronary artery disease?
Effect estimate: AUC 0.995
A biomarker panel combining MMP-9, TIMP-2, and Apo-CIII accurately discriminates CAD presence and severity, suggesting potential utility in clinical risk stratification.
May aid CAD severity research; hypothesis-generating and should not change practice without prospective validation.
Matrix metalloproteinases (MMPs) are implicated in atherosclerotic plaque rupture and recondition. Specific tissue inhibitors (TIMPs) control MMP functions. Both MMPs and TIMPs are potential biomarkers of plaque instability. Elevated Apo-CII and CIII and Apo-E levels are recognized as cardiovascular disease risk factors. We aimed to establish the best blood biomarker panel to evaluate the coronary artery disease (CAD) severity. Plasma levels of MMP-3 and MMP-9, TIMP-1 and TIMP-2, Apo-CII, Apo-CIII and Apo-E were measured in 472 patients with CAD evaluated by coronary angiography and electrocardiography, and in 285 healthy controls. MMP-3 and MMP-9 plasma levels in CAD patients were significantly increased (P < 0.001) compared to controls (3.54- and 3.81-fold, respectively). Furthermore, these increments are modulated by CAD severity as well as for Apo-CII and Apo-CIII levels (P < 0.001). TIMPs levels were decreased in CAD versus controls (P < 0.001) and in inverse correlation to MMPs. Standard ROC curve approach showed the importance of panels of biomarkers, including MMP-3, MMP-9, TIMP-1, TIMP-2, Apo-CII and Apo-CIII, for disease aggravation diagnosis. A high area under curve (AUC) value (0.995) was reached for the association of MMP-9, TIMP-2 and Apo-CIII. The unbalance between MMPs and TIMPs in vascular wall and dyslipidaemia creates favourable conditions for plaque disruption. Our study suggests that the combination of MMP-9, TIMP-2 and Apo-CIII values ('CAD aggravation panel') characterizes the severity of CAD, that is electrophysiological state, number of involved vessels, stent disposal and type of stent.
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Braiek et al. (2020) conducted a case-control in Coronary Artery Disease (CAD) (n=757). Biomarker panel (MMP-9, TIMP-2, and Apo-CIII) vs. Healthy controls was evaluated on Diagnosis of disease aggravation (number of involved vessels) (AUC 0.995). A biomarker panel combining MMP-9, TIMP-2, and Apo-CIII accurately characterized the severity of coronary artery disease, achieving an area under the curve of 0.995.
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