Enhanced Discrimination of Coronary Artery Disease Severity by Circulating Phoenixin-14: Evidence from a Clinical Laboratory Study

Early identification of anatomically significant coronary artery disease (CAD) remains a major clinical challenge despite advances in cardiovascular diagnostics. Novel circulating biomarkers may improve risk stratification and diagnostic discrimination beyond conventional parameters. We investigated the diagnostic utility of four emerging biomarkers—Phoenixin-14, Syntenin-1, Alamandine, and Cerebellin-1—for the assessment of CAD severity. In this prospective observational study, 90 participants undergoing coronary angiography were categorized into three groups: severe CAD (≥70% stenosis; n = 30), non-obstructive/non-critical CAD (<70% stenosis; n = 30), and angiographically normal controls (n = 30). Patients with acute coronary syndrome, diabetes mellitus, prior coronary revascularization, cardiomyopathy, or significant systemic disease were excluded. Circulating biomarker concentrations were quantified using the enzyme-linked immunosorbent assay. Comparative analyses, correlation testing, and receiver operating characteristic (ROC) analyses were performed to evaluate discriminatory performance. Circulating Phoenixin-14 concentrations progressively declined across the control, non-critical CAD, and severe CAD groups 40.1 (29.0–49.7) vs. 24.4 (18.5–30.1) vs. 16.7 (13.4–19.0) pg/mL, respectively; p < 0.001. Phoenixin-14 demonstrated outstanding discrimination for severe CAD, achieving an area under the ROC curve (AUC) of 0.969 (95% CI, 0.888–0.997), with 86.7% sensitivity and 96.7% specificity at a threshold of ≤20.2 pg/mL. Diagnostic performance was substantially lower for Syntenin-1 (AUC, 0.795), Alamandine (AUC, 0.661), and Cerebellin-1 (AUC, 0.597). Phoenixin-14 also showed robust discrimination for non-critical CAD (AUC, 0.832). Biomarker concentrations exhibited correlations with metabolic indices while remaining largely independent of traditional cardiovascular risk factors. Among the evaluated novel circulating biomarkers, Phoenixin-14 demonstrated superior diagnostic performance for both obstructive and non-obstructive CAD, markedly outperforming Syntenin-1, Alamandine, and Cerebellin-1. These findings identify Phoenixin-14 as a promising candidate biomarker for CAD severity assessment and clinical risk stratification. Larger multicenter studies are warranted to validate these exploratory findings and determine their incremental value in contemporary cardiovascular practice.