Work

Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome

Year: 2026

Type: article

Abstract: 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.

Source: Journal of the American Heart Association

DOI: 10.1161/jaha.125.048737