A Clinical and Biomarker Scoring System to Predict the Presence of Obstructive Coronary Artery Disease

作者：Ibrahim Nasrien E; Januzzi A James L Jr^*; Magaret Craig A; Gaggin Hanna K; Rhyne Rhonda F; Gandhi Parul U; Kelly Noreen; Simon Mandy L; Motiwala Shweta R; Belcher Arianna M; van Kimmenade Roland R J

来源：Journal of the American College of Cardiology, 2017, 69(9): 1147-1156.

DOI：10.1016/j.jacc.2016.12.021

• diagnosis
• myocardial infarction
• negative predictive value
• positive predictive value
• stenosis

BACKGROUND Noninvasive models to predict the presence of coronary artery disease (CAD) may help reduce the societal burden of CAD.
OBJECTIVES From a prospective registry of patients referred for coronary angiography, the goal of this study was to develop a clinical and biomarker score to predict the presence of significant CAD.
METHODS In a training cohort of 649 subjects, predictors of >= 70% stenosis in at least 1 major coronary vessel were identified from >200 candidate variables, including 109 biomarkers. The final model was then validated in a separate cohort (n = 278).
RESULTS The scoring system consisted of clinical variables (male sex and previous percutaneous coronary intervention) and 4 biomarkers (midkine, adiponectin, apolipoprotein C-I, and kidney injury molecule-1). In the training cohort, elevated scores were predictive of >= 70% stenosis in all subjects (odds ratio [ OR]: 9.74; p < 0.001), men (OR: 7.88; p < 0.001), women (OR: 24.8; p < 0.001), and those with no previous CAD (OR: 8.67; p < 0.001). In the validation cohort, the score had an area under the receiver-operating characteristic curve of 0.87 (p < 0.001) for coronary stenosis >= 70%. Higher scores were associated with greater severity of angiographic stenosis. At optimal cutoff, the score had 77% sensitivity, 84% specificity, and a positive predictive value of 90% for >= 70% stenosis. Partitioning the score into 5 levels allowed for identifying or excluding CAD with > 90% predictive value in 42% of subjects. An elevated score predicted incident acute myocardial infarction during 3.6 years of follow up (hazard ratio: 2.39; p < 0.001).
CONCLUSIONS We described a clinical and biomarker score with high accuracy for predicting the presence of anatomically significant CAD.

• 出版日期2017-3-7