Academic Journal
Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome.
| Τίτλος: | Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome. |
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| Συγγραφείς: | Teren A; Department of Cardiology and Intensive Care Medicine Bielefeld University, Klinikum Bielefeld Mitte Bielefeld Germany.; Leipzig Research Centre for Civilisation Diseases (LIFE) University of Leipzig Germany., Netto J; Leipzig Research Centre for Civilisation Diseases (LIFE) University of Leipzig Germany.; Institute for Laboratory Medicine, Microbiology and Pathobiochemistry, University Hospital Ostwestfalen-Lippe (UK-OWL), Campus Klinikum Lippe Bielefeld University Bielefeld Germany.; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics University Hospital Leipzig Germany., Thiery J; Leipzig Research Centre for Civilisation Diseases (LIFE) University of Leipzig Germany.; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics University Hospital Leipzig Germany.; Faculty of Medical Christian-Albrechts-University Kiel Germany., Thiele H; Leipzig Research Centre for Civilisation Diseases (LIFE) University of Leipzig Germany.; Department of Internal Medicine/Cardiology Heart Center Leipzig at Leipzig University Leipzig Germany., Stellbrink C; Department of Cardiology and Intensive Care Medicine Bielefeld University, Klinikum Bielefeld Mitte Bielefeld Germany., Lawin D; Department of Cardiology and Intensive Care Medicine Bielefeld University, Klinikum Bielefeld Mitte Bielefeld Germany., Lawrenz T; Department of Cardiology and Intensive Care Medicine Bielefeld University, Klinikum Bielefeld Mitte Bielefeld Germany., Derda AA; Department of Cardiology and Intensive Care Medicine Bielefeld University, Klinikum Bielefeld Mitte Bielefeld Germany.; Department of Cardiology and Angiology Hannover Medical School Hannover Germany., Henger S; Leipzig Research Centre for Civilisation Diseases (LIFE) University of Leipzig Germany.; Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig Germany., Kirsten H; Leipzig Research Centre for Civilisation Diseases (LIFE) University of Leipzig Germany.; Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig Germany., Scholz M; Leipzig Research Centre for Civilisation Diseases (LIFE) University of Leipzig Germany.; Institute for Medical Informatics, Statistics and Epidemiology University of Leipzig Germany., Kaiser T; Leipzig Research Centre for Civilisation Diseases (LIFE) University of Leipzig Germany.; Institute for Laboratory Medicine, Microbiology and Pathobiochemistry, University Hospital Ostwestfalen-Lippe (UK-OWL), Campus Klinikum Lippe Bielefeld University Bielefeld Germany.; Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics University Hospital Leipzig Germany. |
| Πηγή: | Journal of the American Heart Association [J Am Heart Assoc] 2026 Jun 02; Vol. 15 (11), pp. e048737. Date of Electronic Publication: 2026 May 29. |
| Τύπος έκδοσης: | Journal Article; Observational Study; Research Support, Non-U.S. Gov't |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford : Wiley-Blackwell |
| Ιατρικοί όροι (MeSH): | Coronary Stenosis*/blood , Coronary Stenosis*/mortality , Coronary Stenosis*/therapy , Coronary Stenosis*/diagnostic imaging , Coronary Stenosis*/diagnosis , Natriuretic Peptide, Brain*/blood , Peptide Fragments*/blood , Troponin T*/blood , Myocardial Revascularization*, Biomarkers/blood ; C-Reactive Protein/metabolism ; C-Reactive Protein/analysis ; Glycopeptides/blood ; Interleukin-6/blood ; Aged ; Female ; Humans ; Male ; Middle Aged ; Chronic Disease ; Coronary Angiography ; Predictive Value of Tests ; Prognosis ; Prospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome |
| Περίληψη: | Background: The diagnostic and prognostic roles of cardiovascular biomarkers in chronic coronary syndrome remain unclear. Methods: Patients undergoing coronary angiography for suspected chronic coronary syndrome were prospectively enrolled (n=2251; median follow-up 12.6 years). Obstructive coronary artery disease was defined as ≥50% stenosis in ≥1 major epicardial vessel. HsTnT (high-sensitivity cardiac troponin T), NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity C-reactive protein, interleukin-6, and copeptin were measured. Receiver operating characteristic analysis and Cox regression with biomarker × treatment interaction testing were performed. Results: Overall, 888 patients (39.4%) had obstructive coronary artery disease. Only hsTnT showed meaningful diagnostic capacity (area under the curve 0.669; risk factor-weighted clinical likelihood area under the curve 0.663), with incremental benefit inversely proportional to risk factor-weighted clinical likelihood category (Δ area under the curve: very low 10.4%, low 8.0%, intermediate/high 5.0%). NT-proBNP was the strongest mortality predictor across optimal medical therapy (hazard ratio [HR], 1.488 [95% CI, 1.288-1.720], P<0.001), percutaneous coronary intervention (HR, 1.220 [95% CI, 1.020-1.458], P=0.029), and coronary artery bypass grafting (HR, 1.220 [95% CI, 1.049-1.420], P=0.010). Interaction analysis validated a data-derived 150 pg/mL threshold (P=0.032): below it, mortality was comparably low regardless of revascularization (HR, 0.98 [95% CI, 0.67-1.43], P=0.910); above it, baseline risk was markedly elevated (HR, 5.75 [95% CI, 4.10-8.00], P<0.001) and revascularization associated with 40% mortality reduction, with substantial residual risk (HR, 3.43 [95% CI, 2.70-4.40], P<0.001). Conclusions: HsTnT provides risk factor-weighted clinical likelihood category-specific incremental diagnostic value. NT-proBNP is a universal prognostic marker identifying patients with distinct revascularization-associated mortality reduction driven by differential baseline risk. Registration: URL: https://clinicaltrials.gov/study/NCT00497887; Unique Identifier: NCT00497887. |
| Contributed Indexing: | Keywords: B‐type natriuretic peptide; chronic coronary syndrome; pretest probability; revascularization; troponin |
| Molecular Sequence: | ClinicalTrials.gov NCT00497887 |
| Substance Nomenclature: | 0 (Biomarkers) 9007-41-4 (C-Reactive Protein) 0 (copeptins) 0 (Glycopeptides) 0 (IL6 protein, human) 0 (Interleukin-6) 114471-18-0 (Natriuretic Peptide, Brain) 0 (Peptide Fragments) 0 (pro-brain natriuretic peptide (1-76)) 0 (Troponin T) |
| Entry Date(s): | Date Created: 20260530 Date Completed: 20260605 Latest Revision: 20260726 |
| Update Code: | 20260726 |
| PubMed Central ID: | PMC13315135 |
| DOI: | 10.1161/JAHA.125.048737 |
| PMID: | 42216272 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 2047-9980 |
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| DOI: | 10.1161/JAHA.125.048737 |