A Blood-Based Gene Expression Test for Obstructive Coronary Artery Disease Tested in Symptomatic Nondiabetic Patients Referred for Myocardial Perfusion Imaging The COMPASS Study

作者：Thomas Gregory S^*; Voros Szilard; McPherson John A; Lansky Alexandra J; Winn Mary E; Bateman Timothy M; Elashoff Michael R; Lieu Hsiao D; Johnson Andrea M; Daniels Susan E; Ladapo Joseph A; Phelps Charles E; Douglas Pamela S; Rosenberg Steven

来源：Circulation-Cardiovascular Genetics, 2013, 6(2): 154-+.

DOI：10.1161/CIRCGENETICS.112.964015

• atherosclerosis
• computed tomography angiography
• coronary angiography
• gene expression
• myocardial perfusion imaging

Background-Obstructive coronary artery disease diagnosis in symptomatic patients often involves noninvasive testing before invasive coronary angiography. A blood-based gene expression score (GES) was previously validated in nondiabetic patients referred for invasive coronary angiography but not in symptomatic patients referred for myocardial perfusion imaging (MPI). %26lt;br%26gt;Methods and Results-This prospective, multicenter study obtained peripheral blood samples for GES before MPI in 537 consecutive patients. Patients with abnormal MPI usually underwent invasive coronary angiography; all others had research coronary computed tomographic angiography, with core laboratories defining coronary anatomy. A total of 431 patients completed GES, coronary imaging (invasive coronary angiography or computed tomographic angiography), and MPI. Mean age was 56 +/- 10 years (48% women). The prespecified primary end point was GES receiver-operating characteristics analysis to discriminate %26gt;= 50% stenosis (15% prevalence by core laboratory analysis). Area under the receiver-operating characteristics curve for GES was 0.79 (95% confidence interval, 0.73-0.84; P%26lt;0.001), with sensitivity, specificity, and negative predictive value of 89%, 52%, and 96%, respectively, at a prespecified threshold of %26lt;= 15 with 46% of patients below this score. The GES outperformed clinical factors by receiver-operating characteristics and reclassification analysis and showed significant correlation with maximum percent stenosis. Six-month follow-up on 97% of patients showed that 27 of 28 patients with adverse cardiovascular events or revascularization had GES %26gt;15. Site and core-laboratory MPI had areas under the curve of 0.59 and 0.63, respectively, significantly less than GES. %26lt;br%26gt;Conclusions-GES has high sensitivity and negative predictive value for obstructive coronary artery disease. In this population clinically referred for MPI, the GES outperformed clinical factors and MPI.

• 出版日期2013-4