Abstract 407: Use of a Previously Validated Blood-based Test Demonstrates Increased Diagnostic Accuracy as Measured by AUC over Usual Care in the Evaluation of Obstructive Coronary Artery Disease in Males and Females
| Autor: | Mark Monane, Robert Honigberg, Alexandra J. Lansky, Matthew J. Budoff, James A. Wingrove, John A. McPherson, Brian Kent Rhees, Andrea Johnson |
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| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry Diagnostic accuracy medicine.disease Surgery Test (assessment) Coronary artery disease Invasive coronary angiography Myocardial perfusion imaging Cardiac computed tomography angiography Patient age Internal medicine Usual care medicine Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Arteriosclerosis, Thrombosis, and Vascular Biology. 35 |
| ISSN: | 1524-4636 1079-5642 |
| DOI: | 10.1161/atvb.35.suppl_1.407 |
| Popis: | Background: Current evaluation of stable, non-acute patients presenting with symptoms suggestive of obstructive coronary artery disease (CAD) is costly and often exposes patients to radiation and contrast-dye side effects. These risks are coupled with relative poor diagnostic accuracy, as consistently demonstrated by low yields at invasive coronary angiography. We hypothesized that the use of a previously validated blood-based test incorporating age, sex and whole-blood gene expression, in conjunction with a clinician’s clinical assessment, may improve on usual care methods for the evaluation of these patients. Methods and Results: This analysis includes evaluable data from two prospective multicenter clinical studies [[Unable to Display Character: –]] PREDICT (NCT005617, N=523) and COMPASS (NCT1117506, N=431) where patients were assessed for both pre-test CAD risk according to Diamond-Forrester (D-F) criteria as well as for obstructive CAD using either invasive coronary angiography or cardiac computed tomography angiography (CCTA). All patients in COMPASS were also assessed by myocardial perfusion imaging (MPI); a subset of N=307 subjects were assessed by MPI in PREDICT. Previously, we demonstrated diagnostic superiority, as measured by AUC, for a score combining patient age, sex and whole-blood gene expression (ASGES), in a combined set of men and women from both PREDICT (ASGES = 70%, D-F = 66%, MPI = 54%) and COMPASS (ASGES = 79%, D-F = 69%, MPI = 59%). In this expanded analysis, we report results stratified by sex and demonstrate superiority of the ASGES, as measured by AUC, to MPI for males and females in PREDICT (male ASGES = 66%, MPI = 55%; female ASGES = 65%, MPI = 48%) and in COMPASS (male ASGES = 73%, MPI=60%; female ASGES 73%, MPI = 55% respectively). In addition, we demonstrate that ASGES improves CAD risk classification when compared to D-F criteria in females in both PREDICT (ASGES = 65%, D-F = 51%) and COMPASS (ASGES = 73%, D-F = 58%). Conclusions: We demonstrate that use of a gender-specific, blood-based test incorporating age, sex, and gene expression provides better diagnostic accuracy for patients considered for referral to cardiology and advanced cardiac testing, when compared to usual care methods of D-F type risk classification and MPI. |
| Databáze: | OpenAIRE |
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