Combining Anatomical and Biochemical Markers in the Detection and Risk Stratification of Coronary Artery Disease

Overview

Journal Eur Heart J Cardiovasc Imaging

Publisher Oxford University Press

Specialties Cardiology & Vascular Diseases
Radiology

Date 2024 Apr 9

PMID 38591997

Authors

Miriam Albus

Tobias Zimmermann

Daniela Median

Klara Rumora

Ganna Isayeva

Melissa Amrein

Ibrahim Schaefer

Joan Walter

Evita Michel

Gabrielle Hure

Ivo Strebel

Federico Caobelli

Philip Haaf

Simon M Frey

Christian Mueller

Michael J Zellweger

Affiliations

Soon will be listed here.

Abstract

Aims: We aimed to test the hypothesis if combining coronary artery calcium score (Ca-score) as a quantitative anatomical marker of coronary atherosclerosis with high-sensitivity cardiac troponin as a quantitative biochemical marker of myocardial injury provided incremental value in the detection of functionally relevant coronary artery disease (fCAD) and risk stratification.

Methods And Results: Consecutive patients undergoing myocardial perfusion single-photon emission computed tomography (MPS) without prior CAD were enrolled. The diagnosis of fCAD was based on the presence of ischaemia on MPS and coronary angiography; fCAD was centrally adjudicated in the diagnostic and prognostic domain. Diagnostic accuracy was evaluated using the area under the receiver-operating characteristic curve (AUC). The composite of cardiovascular death and non-fatal acute myocardial infarction (AMI) within 730 days was the primary prognostic endpoint. Among 1715 patients eligible for the diagnostic analysis, 399 patients had fCAD. The combination of Ca-score and high-sensitivity cardiac troponin T (hs-cTnT) had good diagnostic accuracy for the diagnosis of fCAD (AUC 0.79, 95% confidence interval (CI) 0.77-0.81), but no incremental value compared with the Ca-score alone (AUC 0.79, 95% CI 0.77-0.81, P = 0.965). Similar results were observed using high-sensitivity cardiac troponin I (AUC 0.80, 95% CI 0.77-0.82) instead of hs-cTnT. Among 1709 patients (99.7%) with available follow-up, 59 patients (3.5%) suffered the composite primary prognostic endpoint (non-fatal AMI, n = 34; CV death, n = 28). Both Ca-score and hs-cTnT had independent prognostic value. Increased risk was restricted to patients with elevation in both markers.

Conclusion: The combination of the Ca-score with hs-cTnT increases the prognostic accuracy for future events but does not provide incremental value vs. the Ca-score alone for the diagnosis of fCAD.

Study Registration: Clinical trial registration: NCT00470587.

References

Mittal T, Pottle A, Nicol E, Barbir M, Ariff B, Mirsadraee S . Prevalence of obstructive coronary artery disease and prognosis in patients with stable symptoms and a zero-coronary calcium score. Eur Heart J Cardiovasc Imaging. 2017; 18(8):922-929. PMC: 5837484. DOI: 10.1093/ehjci/jex037. View

Walter J, Tanglay Y, du Fay de Lavallaz J, Strebel I, Boeddinghaus J, Twerenbold R . Clinical utility of circulating interleukin-6 concentrations in the detection of functionally relevant coronary artery disease. Int J Cardiol. 2018; 275:20-25. DOI: 10.1016/j.ijcard.2018.10.029. View

Laufer E, Mingels A, Winkens M, Joosen I, Schellings M, Leiner T . The extent of coronary atherosclerosis is associated with increasing circulating levels of high sensitive cardiac troponin T. Arterioscler Thromb Vasc Biol. 2010; 30(6):1269-75. DOI: 10.1161/ATVBAHA.109.200394. View

Kim B, Choi S, Lee S, Kim C, Ryu W, Han M . Advanced coronary artery calcification is associated with ischemic stroke. Cerebrovasc Dis. 2010; 30(1):93-100. DOI: 10.1159/000314711. View

Hermann D, Gronewold J, Lehmann N, Moebus S, Jockel K, Bauer M . Coronary artery calcification is an independent stroke predictor in the general population. Stroke. 2013; 44(4):1008-13. DOI: 10.1161/STROKEAHA.111.678078. View

Agatston A, Janowitz W, HILDNER F, Zusmer N, VIAMONTE Jr M, Detrano R . Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990; 15(4):827-32. DOI: 10.1016/0735-1097(90)90282-t. View

Freda B, Tang W, Van Lente F, Peacock W, Francis G . Cardiac troponins in renal insufficiency: review and clinical implications. J Am Coll Cardiol. 2002; 40(12):2065-71. DOI: 10.1016/s0735-1097(02)02608-6. View

Rusnak J, Behnes M, Henzler T, Reckord N, Vogler N, Meyer M . Comparative analysis of high-sensitivity cardiac troponin I and T for their association with coronary computed tomography-assessed calcium scoring represented by the Agatston score. Eur J Med Res. 2017; 22(1):47. PMC: 5691858. DOI: 10.1186/s40001-017-0290-9. View

Krintus M, Kozinski M, Boudry P, Capell N, Koller U, Lackner K . European multicenter analytical evaluation of the Abbott ARCHITECT STAT high sensitive troponin I immunoassay. Clin Chem Lab Med. 2014; 52(11):1657-65. DOI: 10.1515/cclm-2014-0107. View

10.

Takamura K, Kondo T, Fujimoto S, Hiki M, Matsumori R, Kawaguchi Y . Incremental predictive value for obstructive coronary artery disease by combination of Duke Clinical Score and Agatston score. Eur Heart J Cardiovasc Imaging. 2015; 17(5):550-6. DOI: 10.1093/ehjci/jev233. View

11.

DeLong E, Delong D, Clarke-Pearson D . Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988; 44(3):837-45. View

12.

Nguyen H, Liu J, Del Castillo M, Shah T . Role of Coronary Calcium Score to Identify Candidates for ASCVD Prevention. Curr Atheroscler Rep. 2019; 21(12):53. DOI: 10.1007/s11883-019-0812-8. View

13.

Giannitsis E, Becker M, Kurz K, Hess G, Zdunek D, Katus H . High-sensitivity cardiac troponin T for early prediction of evolving non-ST-segment elevation myocardial infarction in patients with suspected acute coronary syndrome and negative troponin results on admission. Clin Chem. 2010; 56(4):642-50. DOI: 10.1373/clinchem.2009.134460. View

14.

Broersen L, Stengl H, Nolte C, Westermann D, Endres M, Siegerink B . Association Between High-Sensitivity Cardiac Troponin and Risk of Stroke in 96 702 Individuals: A Meta-Analysis. Stroke. 2020; 51(4):1085-1093. DOI: 10.1161/STROKEAHA.119.028323. View

15.

Walter J, Honegger U, Puelacher C, Mueller D, Wagener M, Schaerli N . Prospective Validation of a Biomarker-Based Rule Out Strategy for Functionally Relevant Coronary Artery Disease. Clin Chem. 2017; 64(2):386-395. DOI: 10.1373/clinchem.2017.277210. View

16.

Shaw L, Giambrone A, Blaha M, Knapper J, Berman D, Bellam N . Long-Term Prognosis After Coronary Artery Calcification Testing in Asymptomatic Patients: A Cohort Study. Ann Intern Med. 2015; 163(1):14-21. DOI: 10.7326/M14-0612. View

17.

Ladapo J, Blecker S, Douglas P . Physician decision making and trends in the use of cardiac stress testing in the United States: an analysis of repeated cross-sectional data. Ann Intern Med. 2014; 161(7):482-90. PMC: 4335355. DOI: 10.7326/M14-0296. View

18.

Madsen D, Diederichsen A, Hosbond S, Gerke O, Mickley H . Diagnostic and prognostic value of a careful symptom evaluation and high sensitive troponin in patients with suspected stable angina pectoris without prior cardiovascular disease. Atherosclerosis. 2016; 258:131-137. DOI: 10.1016/j.atherosclerosis.2016.11.030. View

19.

Rijlaarsdam-Hermsen D, Lo-Kioeng-Shioe M, Kuijpers D, van Domburg R, Deckers J, van Dijkman P . Prognostic value of the coronary artery calcium score in suspected coronary artery disease: a study of 644 symptomatic patients. Neth Heart J. 2019; 28(1):44-50. PMC: 6940415. DOI: 10.1007/s12471-019-01335-7. View

20.

Hanifehpour R, Motevalli M, Ghanaati H, Shahriari M, Ghasabeh M . Diagnostic Accuracy of Coronary Calcium Score Less than 100 in Excluding Coronary Artery Disease. Iran J Radiol. 2016; 13(2):e16705. PMC: 5035795. DOI: 10.5812/iranjradiol.16705. View