Abstract 16357: Identification of Circulating Proteins that Predict the Presence of Obstructive Coronary Artery Disease in Symptomatic, Non-Diabetic Patients Referred for Invasive Coronary Angiography

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
James Wingrove ◽  
Karen Fitch ◽  
Phil Beineke ◽  
Steven Rosenberg
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Diabetic Patients ◽  
Protein Markers ◽  
Adjusted Analysis ◽  
Major Coronary Artery ◽  
Artery Disease

Background: The diagnosis of patients presenting for the first time with typical or atypical symptoms consistent with obstructive coronary artery disease (CAD) remains challenging; despite the existence of a number of non-invasive modalities for the assessment of CAD, the yield of obstructive CAD in patients who undergo invasive coronary angiography remains low. We sought to identify circulating protein biomarkers that might aid in the diagnosis of obstructive CAD in non-diabetic patients. Methods: 386 non-diabetic patients from the PREDICT study (NCT00500617) were divided into two independent case:control sets for initial marker discovery (Set 1, n=187) and preliminary model validation (Set 2, n=199). Cases were defined as patients with ≥50% stenosis in ≥1 major coronary artery; controls had < 50% stenosis in any major coronary artery as determined by quantitative coronary angiography (QCA). In 11% of the patients QCA was not available and 70% stenosis by clinical read was used as a case threshold. 135 protein markers were evaluated in plasma from Set 1 patients using an electrochemoluminescence-based platform (MesoScale); the top markers were analyzed in Set 2 and used to develop predictive models using penalized logistic regression (LASSO). Model performance was estimated via 2500 iteration of cross validation on random holdout sets of 14 patients. Results: In a sex and age adjusted analysis, nine protein markers obtained nominal significance (p < 0.05) in Set 1, with 9 additional markers trending towards significance (p 0.7); the average of these pairs was used for subsequent analysis. Top markers were evaluated in Set 2 and a five marker (Adiponectin, ApoA1, NT-proBNP, S100A8-MPO, PlGF) model was fitted via LASSO, resulting in a mean cross-validated AUC of 0.64. Conclusion: We have identified a set of plasma protein markers in subjects referred for invasive angiography, which in age and sex adjusted analysis are responsive to the presence of obstructive CAD. Use of such protein markers alone, or in combination with other genomic markers or clinical risk factors may aid in the identification of obstructive CAD in non-acute, symptomatic patients.

Abstract 19638: A High Percentage of Patients Referred for Invasive Coronary Angiography Found to Have No Obstructive Coronary Artery Disease are Referred for Appropriate Indications

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michelle Ouellette ◽  
Virginia Workman ◽  
Adrian Loffler ◽  
George A Beller ◽  
Jamieson M Bourque
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stress Test ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Coronary Syndrome ◽  
Obstructive Disease ◽  
Number Of Patients ◽  
Artery Disease

Introduction: The incidence of normal coronary arteries in patients referred for invasive coronary angiography (ICA) ranges from 30-60%. We sought to evaluate patterns of referral, assess the rate of appropriate catheterization and determine the prevalence of coronary artery disease (CAD) in our population by appropriateness and indication. Methods: Retrospective analysis was performed on 930 consecutive patients undergoing diagnostic ICA. Indications for ICA were reviewed and appropriate use criteria (AUC) were applied to the cohort retrospectively. Patients with known CAD, prior MI, CHF, or indication for pre-transplant workup or cardiac surgery were excluded. Rates of non-obstructive (21-49% stenosis) and obstructive CAD (≥50%) were compared by appropriateness status using Fisher’s Exact Testing. Results: Of the 930 patients studied, 55.6% were male with median age of 62 and 10-year ASCVD risk score of 17.7%. Acute coronary syndrome (ACS) was the most prevalent indication for referral (48.5%) with a 68.6% prevalence of obstructive CAD. A positive stress test was the indication in 18.9% with a 51.4% rate of obstructive CAD. The rates of the remaining referral indications are given in Figure 1. In those referred appropriately for angiography (n=923), the prevalence of obstructive disease was 55.9% (n=516), non-obstructive disease 13.6% (n=125), and normal coronaries 30.6%(n=282). Inappropriate referral was identified in only 7 patients (0.8%), all of whom had normal coronaries with p<0.001. Conclusions: At a single quaternary care academic center the majority of coronary angiographies performed invasively are appropriate by AUC. Despite adherence to AUC, there continues to be a large number of patients with no evidence of obstructive disease, including in those with ACS. Further research is needed to further refine the AUC and its role in risk stratification for obstructive CAD.

Abstract 04: Diagnostic Accuracy of Coronary CT in Survivors of Out-Of-Hospital Circulatory Arrest: Can CT Serve as a Gatekeeper for Invasive Coronary Angiography?

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Kelley R Branch ◽  
Ravi Hira ◽  
Robin M Brusen ◽  
Charles Maynard ◽  
Medley Gatewood ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Diagnostic Accuracy ◽  
Circulatory Arrest ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Patient Level ◽  
Coronary Ct ◽  
Artery Disease

Introduction: Out-of-hospital circulatory arrest (OHCA) is commonly assumed to be from a cardiac cause although routine early invasive coronary angiography (ICA) remains controversial and has a relatively high proportion of studies without obstructive coronary artery disease (CAD). The ability of coronary CT angiography (CCTA) to detect significant CAD in OHCA survivors has not been evaluated. Methods: The prospective CT-FIRST trial enrolled 104 OHCA survivors who had an early (<6 hours from hospital arrival) head-to-pelvis CT scan that included an ECG-gated CCTA (FORCE CT, Siemens). The CCTA scanned 0-90% of the cardiac cycle without routine use of beta blockers or nitroglycerin. Treating physicians were blinded to the CCTA analysis. ICA was ordered at the discretion of treating physicians. Readers blinded to corresponding studies analyzed CCTA and ICA for coronary stenoses using a 20 segment coronary model. Obstructive CAD was assumed for >50% stenosis. Patient-level diagnostic accuracy calculations for CCTA to identify obstructive CAD used ICA as the standard. Results: Of the 104 enrolled patients, 28 (27%) had both CT and ICA. All CCTA studies were evaluable. Diagnostic accuracy data are shown in the Table. Overall, diagnostic accuracy measures were excellent between CCTA and ICA at the patient level. Conclusions: Early CCTA in OHCA survivors has high diagnostic accuracy for obstructive coronary artery disease and could be used as a gatekeeper to ICA.

Abstract 214: A Blood-based Precision Medicine Test Score is Additive in Determining a Patient’s Risk of Obstructive Coronary Artery Disease After Positive Myocardial Perfusion Imaging: Results From the PREDICT and COMPASS Studies

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Alexandra Lansky ◽  
John McPherson ◽  
Nic Chronos ◽  
Kari Schmitz ◽  
Jim Wingrove ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Myocardial Perfusion Imaging ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Precision Medicine ◽  
Perfusion Imaging ◽  
Invasive Coronary Angiography ◽  
Obstructive Coronary Artery Disease ◽  
Artery Disease

Background: Myocardial perfusion imaging (MPI) is the predominant diagnostic tool for evaluating outpatients with typical and atypical symptoms suggestive of obstructive coronary artery disease (CAD) and is commonly followed by invasive coronary angiography in patients with abnormal findings. Despite this paradigm, a significant proportion of patients do not need intervention, suggesting better diagnostic methods are needed to identify appropriate patients who would benefit from the risks, resource utilization, and healthcare costs incurred after a positive MPI. A previously validated, blood-based test incorporating age, sex and genomic expression score (ASGES) utilizing peripheral blood cell expression has demonstrated clinical validity in assessing the likelihood of obstructive CAD (≥50% luminal diameter stenosis by quantitative coronary angiography) early in the cardiac workup. Objective: The objective of this study is to evaluate if the utilization of the ASGES in conjunction with a positive MPI would assist in the determination of a patient’s risk of obstructive coronary artery disease. Methods: A total of 249 patients (mean age 58, 45% female) from 59 sites in the PREDICT (NCT00500617) and COMPASS (NCT01117506) studies were identified with a positive MPI study, defined as at least one reversible of fixed defect consistent with obstructive CAD and a subsequent invasive coronary angiography. ASGES scores were performed in all patients and were categorized into 3 groups based on score: low (1-15, 25%), mid-range (16-27, 43%) and high (28-40, 32%). Obstructive CAD rates defined by invasive coronary angiography were measured. The association between obstructive CAD and ASGES was evaluated using Cochran-Armitage trend test and area under the receiver-operating characteristics curve (AUC) analyses. Results: The rate of obstructive CAD among patients with a positive MPI was 35% (88/249). There was a net redistribution of risk based on ASGES testing in 52% (49/88) of these patients. The rate of obstructive CAD was 11% (7/63), 37% (39/106), and 53% (42/80) in the low, mid-range, and high score groups respectively (p<0.001). AUC for the ASGES use with a positive MPI was 0.704. Conclusion: The ASGES test, when used in patients after positive MPI, improved the diagnostic accuracy in the assessment of obstructive CAD. The use of this precision medicine test may help minimize unnecessary referral of low-intermediate risk patients as well as improve diagnostic yield among patients with abnormal MPI findings scheduled to undergo invasive coronary angiography.

scholarly journals Diagnostic and prognostic value of coronary artery calcium score of zero: is it time for guidelines to change?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Arbas Redondo ◽  
D Tebar Marquez ◽  
I.D Poveda Pinedo ◽  
R Dalmau Gonzalez-Gallarza ◽  
S.C Valbuena Lopez ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Calcium ◽  
Cardiac Ct ◽  
Invasive Coronary Angiography ◽  
Agatston Score ◽  
Non Invasive ◽  
Artery Disease

Abstract Introduction Cardiac computed tomography (CT) use has progressively increased as the preferred initial test to rule out coronary artery disease (CAD) when clinical likelihood is low. Coronary artery calcium (CAC) detected by CT is a well-established marker for cardiovascular risk. However, it is not recommended for diagnosis of obstructive CAD. Absence of CAC, defined as an Agatston score of zero, has been associated to good prognosis despite underestimation of non-calcified plaques. Purpose To evaluate whether zero CAC score could help ruling out obstructive CAD in a safely manner. Methods Observational study based on a prospective database of patients (pts) referred to cardiac CT between 2017 and 2019. Pts with an Agatston score of zero were selected. Results We included 176 pts with zero CAC score and non-invasive coronary angiography performed. The median duration of follow-up was 23.9 months. Baseline characteristics of the population are shown in Table 1. In 117 pts (66.5%), cardiac CT was indicated as part of their chest pain evaluation. Mean age was 57.2 years old, 68.2% were women and only and 9.4% were active smokers. Normal coronary arteries were found in 173 pts (98.3%). Obstructive CAD, defined as ≥50% luminal diameter stenosis of a major vessel, was present in 1/176 (0.6%); while non-obstructive atherosclerotic plaques were found in 2 pts (1.1%). During follow-up, one patient died of out-of-hospital cardiac arrest. None either suffered from myocardial infarction or needed coronary revascularization. Conclusions In our cohort, a zero CAC score detected by cardiac CT rules out obstructive coronary artery disease in 98.3%, with only 1.7% of non-calcified atherosclerosis plaques and 0.6% of major adverse events. Although further research on this topic is needed, these results support the fact that non-invasive coronary angiography could be avoided in patients with low clinical likelihood of CAD and zero CAC score, facilitating the management of the increasing demand for coronary CT and reduction of radiation dose. Funding Acknowledgement Type of funding source: None

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