Pathway-Specific Aggregate Biomarker Risk Score Is Associated With Burden of Coronary Artery Disease and Predicts Near-Term Risk of Myocardial Infarction and Death

• DOI: 10.1161/circoutcomes.115.001493
• Publication Date: 2017-03-10T02:11:04Z
• Authors: Nima Ghasemzadeh; Salim S. Hayek; Yi-An Ko; Danny J. Eapen; Riyaz S. Patel; Pankaj Manocha; Hatem Al Kassem; Mohamed Khayata; Emir Veledar; Dimitrios Kremast...; Christian W. Thor...; Tomasz Pielak; Sergey Sikora; A. Maziar Zafari; Stamatios Lerakis; Laurence Sperling; Viola Vaccarino; Stephen E. Epstein; Arshed A. Quyyumi
• Keywords: Male; Cardiac & Cardiovascular Systems; Myocardial Infarction; UROKINASE RECEPTOR; HEART-DISEASE; Coronary Artery Disease; risk score; Coronary Angiography; Risk Assessment; Severity of Illness Index; Receptors, Urokinase Plasminogen Activator; Fibrin Fibrinogen Degradation Products; 03 medical and health sciences; Endocrinology; 0302 clinical medicine; Predictive Value of Tests; Risk Factors; Medicine and Health Sciences; Humans; HSP70 Heat-Shock Proteins; 10. No inequality; PLASMINOGEN-ACTIVATOR RECEPTOR; Aged; Proportional Hazards Models; GENERAL-POPULATION; 2. Zero hunger; Science & Technology; MORTALITY; Diabetes; Middle Aged; Prognosis; CANCER; cardiovascular outcomes; C-REACTIVE PROTEIN; 3. Good health; C-Reactive Protein; and Metabolism; ATHEROSCLEROSIS; CARDIOVASCULAR-DISEASE; Cardiovascular System & Cardiology; Disease Progression; biomarker; Female; prognosis; Life Sciences & Biomedicine; coronary artery disease; CELL-ADHESION; Biomarkers

Background— Inflammation, coagulation, and cell stress contribute to atherosclerosis its adverse events. A biomarker risk score (BRS) based on the circulating levels of biomarkers C-reactive protein, fibrin degradation products, heat shock protein-70 representing these 3 pathways was a strong predictor future outcomes. We investigated whether soluble urokinase plasminogen activator receptor (suPAR), marker immune activation, is predictive outcomes independent aforementioned markers addition 3-BRS improves reclassification. Methods Results— product, protein-70, suPAR were measured in 3278 patients undergoing coronary angiography. The BRS calculated by counting number above cutoff determined using Youden’s index. Survival analyses performed models adjusted for traditional factors. high level ≥3.5 ng/mL associated with all-cause death myocardial infarction (hazard ratio, 1.83; 95% confidence interval, 1.43–2.35) after adjustment factors, protein-70. Addition significantly improved C statistic, integrated discrimination improvement, net reclassification index primary outcome. 1, 2, 3, or 4 1.81-, 2.59-, 6.17-, 8.80-fold increase, respectively, infarction. 4-BRS also severity artery disease composite end points. Conclusions— SuPAR independently outcomes, comprising clinical utility prediction management warrants further study.