Whole Blood Gene Expression Testing for Coronary Artery Disease in Nondiabetic Patients: Major Adverse Cardiovascular Events and Interventions in the PREDICT Trial

• Published in: Journal of cardiovascular translational research Vol. 5; no. 3; pp. 366 - 374
• Main Authors: Rosenberg, Steven, Elashoff, Michael R., Lieu, Hsiao D., Brown, Bradley O., Kraus, William E., Schwartz, Robert S., Voros, Szilard, Ellis, Stephen G., Waksman, Ron, McPherson, John A., Lansky, Alexandra J., Topol, Eric J.
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.06.2012
• Subjects: Adult; Aged; Aged, 80 and over; Angiography; Angioplasty, Balloon, Coronary; Biomedical Engineering and Bioengineering; Biomedicine; Blood; Cardiology; Clinical trials; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease - complications; Coronary Artery Disease - diagnosis; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - genetics; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Female; Gene expression; Gene Expression Regulation; Genetic Predisposition to Disease; Genetic Testing; Heart diseases; Human Genetics; Humans; Ischemic Attack, Transient - etiology; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Myocardial Infarction - etiology; Odds Ratio; Phenotype; Predictive Value of Tests; Prognosis; Prospective Studies; Reproducibility of Results; Risk Assessment; Risk Factors; Stroke - etiology; Time Factors; Translation; United States; Peripheral blood gene expression; Angiography; Coronary interventions; MACE; Coronary artery disease; Genomics
• ISSN: 1937-5387; 1937-5395
• DOI: 10.1007/s12265-012-9353-z

The majority of first-time angiography patients are without obstructive coronary artery disease (CAD). A blood gene expression score (GES) for obstructive CAD likelihood was validated in the PREDICT study, but its relation to major adverse cardiovascular events (MACE) and revascularization was not assessed. Patients ( N  = 1,160) were followed up for MACE and revascularization 1 year post-index angiography and GES, with 1,116 completing follow-up. The 30-day event rate was 23% and a further 2.2% at 12 months. The GES was associated with MACE/revascularizations ( p  < 0.001) and added to clinical risk scores. Patients with GES >15 trended towards increased >30 days MACE/revascularization likelihood (odds ratio = 2.59, 95% confidence interval = 0.89–9.14, p  = 0.082). MACE incidence overall was 1.5% (17 of 1,116) and 3 of 17 patients had GES ≤15. For the total low GES group ( N  = 396), negative predictive value was 90% for MACE/revascularization and >99% for MACE alone, identifying a group of patients without obstructive CAD and highly unlikely to suffer MACE within 12 months.