Use of a blood test incorporating age, sex, and gene expression influences medical decision-making in the evaluation of women presenting with symptoms suggestive of obstructive coronary artery disease: summary results from two ambulatory care studies in primary care
| Autor: | Lon Castle, Mark Monane, Brian Kent Rhees, John A. McPherson, Bonnie H. Weiner, Joseph A. Ladapo, Lee Herman |
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| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Referral Population Clinical Decision-Making Coronary Artery Disease Chest pain Coronary Angiography Risk Assessment Coronary artery disease Cohort Studies Ambulatory care Predictive Value of Tests Internal medicine medicine Ambulatory Care Blood test Humans Prospective Studies education education.field_of_study medicine.diagnostic_test Primary Health Care business.industry Gene Expression Profiling Obstetrics and Gynecology Odds ratio Middle Aged medicine.disease Predictive value of tests Physical therapy Women's Health Female medicine.symptom business Algorithms |
| Zdroj: | Menopause (New York, N.Y.). 22(11) |
| ISSN: | 1530-0374 |
| Popis: | OBJECTIVE Clinicians need better approaches to evaluating women at midlife and beyond who present to primary care with chest pain and related symptoms. A previously validated blood-based test, which includes age, sex, and gene expression levels, showed a 96% negative predictive value for determining an individual's current likelihood of having obstructive coronary artery disease (CAD) in a combined population of men and women. We hypothesized that age/sex/gene expression score (ASGES) would be incorporated into medical decision-making and would influence the rate of further cardiac evaluation. METHODS An aggregate analysis of female cohorts from the Investigation of a Molecular Personalized Coronary Gene Expression Test on Primary Care Practice Pattern (IMPACT-PCP; NCT01594411) and REGISTRY I (NCT01557855) studies was conducted. Data on 320 women presenting with stable symptoms suggestive of obstructive CAD and undergoing ASGES testing (from 16 primary care providers in geographically diverse sites) were pooled. The primary outcome of this analysis was the association between ASGES and referrals for further cardiac evaluation. RESULTS The mean participant age was 57.8 years, and the mean ASGES (predefined as low [ASGES ≤15] or elevated [ASGES >15]) was 10.3. The referral rate for further cardiac evaluation was 4.0% (10 of 248) for women with low ASGES versus 83.3% (60 of 72) for women with elevated ASGES, with an overall follow-up major adverse cardiac event/revascularization rate of 1.2%. After adjustment for clinical covariates, women with low ASGES were significantly less likely to be referred for further cardiac evaluation (odds ratio, 0.013; P |
| Databáze: | OpenAIRE |
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