MACE Prediction in Coronary Angiography Using Multiple Biomarkers Score

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The score has a 64% sensitivity and 76% specificity.
The score has a 64% sensitivity and 76% specificity.

A multiple biomarker score has been developed to predict incident major adverse cardiovascular events (MACE) in patients undergoing diagnostic coronary angiography, according to research presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology in Washington, DC.

Researchers from Massachusetts General Hospital in Boston evaluated 649 patients who underwent coronary angiography and obtained more than 50 clinical variables and 109 biomarkers. Predictive models were created using LASSO logistic regression, and the score from the final model was validated with a 278-patient validation set.

 

The final scoring system consisted of 4 biomarkers: N-terminal pro B-type natriuretic peptide (NT-proBNP), kidney injury molecule 1, osteopontin, and tissue inhibitor of metalloproteinase-1. Each marker improved the model discrimination or calibration for MACE in the validation cohort. The final score had an AUC of 0.79 (P <.001), which was higher than the AUC for clinical variables (0.75).

Addition of other markers to NT-proBNP resulted in significant improvement in net reclassification analyses (NRI=0.45; P =.008), and similar improvement was seen with clinical variables alone (NRI=0.54; P =.002). The researchers determined the optimal score cut-off in the validation cohort had 64% sensitivity, 76% specificity, 27% positive predictive value, and 93% negative predictive value for MACE.

In addition, Kaplan Meier survival analyses revealed that time to first MACE was much shorter in patients with an elevated biomarker score (P <.001). Although the score was developed for 1-year prediction, the risk extended to at least 4 years.

“In a general population undergoing diagnostic coronary angiography, we describe a multiple biomarker score with high accuracy for predicting incident MACE within 1 year of follow-up,” the researchers concluded.

Reference

McCarthy C, Van Kimmenade R, Gaggin H, et al. Multiple biomarkers for predicting major adverse cardiac events in at-risk patients undergoing diagnostic coronary angiography: results from the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA) Study. Abstract 1126-339. Presented at: the 66th Annual Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.

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