May 29, 2026Journal of the American Heart Association0 citationsOpen Access
View Full PaperCardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome
Key Result
Elevated NT-proBNP was a strong predictor of mortality across optimal medical therapy (HR 1.488; 95% CI 1.288-1.720; P<0.001) and identified patients with revascularization-associated mortality reduction.
Study Design
Type
Cohort (n=2,251)
Structured PICO
Do cardiovascular biomarkers refine pretest probability for coronary obstruction and predict survival after revascularization in patients with suspected chronic coronary syndrome?
P
Population
2,251 patients undergoing coronary angiography for suspected chronic coronary syndrome, followed for a median of 12.6 years.
E
Exposure
Measurement of cardiovascular biomarkers (hsTnT, NT-proBNP, high-sensitivity C-reactive protein, interleukin-6, and copeptin)
O
Outcome
Diagnosis of obstructive coronary artery disease (≥50% stenosis in ≥1 major epicardial vessel) and mortalityhard clinical
HsTnT provides incremental diagnostic value for obstructive CAD, while NT-proBNP is a strong prognostic marker that identifies patients who may derive a mortality benefit from revascularization.
Main Result
Hazard Ratio: 1.488 (95% CI 1.288–1.72)
p-value: p=<0.001
Abstract
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.