Key result
Blood gene expression score >15 linked to ~332% greater risk of 1-year MACE and revascularization.
Why the study?
The relation of a blood gene expression score for obstructive CAD likelihood to major adverse cardiovascular events and revascularization had not been assessed.
Does a blood gene expression score predict major adverse cardiovascular events and revascularization in nondiabetic patients undergoing first-time angiography?
Cohort (n=1,160)
Yes
Does a blood gene expression score predict major adverse cardiovascular events and revascularization in nondiabetic patients undergoing first-time angiography?
A low blood gene expression score (≤15) has a >99% negative predictive value for MACE at 1 year, successfully identifying a cohort of nondiabetic patients highly unlikely to suffer adverse events after first-time angiography.
May aid risk stratification in cardiovascular patients; leaves open whether integration improves outcomes or warrants clinical adoption.
The majority of first-time angiography patients are without obstructive coronary artery disease (CAD). A blood gene expression score (GES) for obstructive CAD likelihood was validated in the PREDICT study, but its relation to major adverse cardiovascular events (MACE) and revascularization was not assessed. Patients (N = 1,160) were followed up for MACE and revascularization 1 year post-index angiography and GES, with 1,116 completing follow-up. The 30-day event rate was 23% and a further 2.2% at 12 months. The GES was associated with MACE/revascularizations (p < 0.001) and added to clinical risk scores. Patients with GES >15 trended towards increased >30 days MACE/revascularization likelihood (odds ratio = 2.59, 95% confidence interval = 0.89-9.14, p = 0.082). MACE incidence overall was 1.5% (17 of 1,116) and 3 of 17 patients had GES ≤ 15. For the total low GES group (N = 396), negative predictive value was 90% for MACE/revascularization and >99% for MACE alone, identifying a group of patients without obstructive CAD and highly unlikely to suffer MACE within 12 months.
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Rosenberg et al. (2012) conducted a cohort in Suspected coronary artery disease (n=1,160). Gene expression score (GES) >15 vs. Gene expression score (GES) ≤15 was evaluated on Composite of major adverse cardiovascular events (MACE) and revascularization procedures at 12 months (OR 4.32, 95% CI 3.02-6.25, p=<0.001). A blood-based gene expression score >15 was significantly associated with an increased likelihood of major adverse cardiovascular events and revascularizations at 1 year (OR 4.32) compared to scores ≤15.
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