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An age- and sex-specific gene expression score is associated with revascularization and coronary artery disease: Insights from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial.

Publication ,  Journal Article
Voora, D; Coles, A; Lee, KL; Hoffmann, U; Wingrove, JA; Rhees, B; Huang, L; Daniels, SE; Monane, M; Rosenberg, S; Shah, SH; Kraus, WE ...
Published in: Am Heart J
February 2017

BACKGROUND: Identifying predictors of coronary artery disease (CAD)-related procedures and events remains a priority. METHODS: We measured an age- and sex-specific gene expression score (ASGES) previously validated to detect obstructive CAD (oCAD) in symptomatic nondiabetic patients in the PROMISE trial. The outcomes were oCAD (≥70% stenosis in ≥1 vessel or ≥50% left main stenosis on CT angiography [CTA]) and a composite endpoint of death, myocardial infarction, revascularization, or unstable angina. RESULTS: The ASGES was determined in 2370 nondiabetic participants (47.5% male, median age 59.5 years, median follow-up 25 months), including 1137 with CTA data. An ASGES >15 was associated with oCAD (odds ratio 2.5 [95% CI 1.6-3.8], P<.001) and the composite endpoint (hazard ratio [HR] 2.6 [95% CI 1.8-3.9], P<.001) in unadjusted analyses. After adjustment for Framingham risk, an ASGES >15 remained associated with the composite endpoint (P=.02); the only component that was associated was revascularization (adjusted HR 2.69 [95% CI 1.52-4.79], P<.001). Compared to noninvasive testing, the ASGES improved prediction for the composite (increase in c-statistic=0.036; continuous net reclassification index=43.2%). Patients with an ASGES ≤15 had a composite endpoint rate no different from those with negative noninvasive test results (3.2% vs. 2.6%, P=.29). CONCLUSIONS: A blood-based genomic test for detecting oCAD significantly predicts near-term revascularization procedures, but not non-revascularization events. Larger studies will be needed to clarify the risk with non-revascularization events.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2017

Volume

184

Start / End Page

133 / 140

Location

United States

Related Subject Headings

  • Transcriptome
  • Sex Factors
  • Risk Assessment
  • Real-Time Polymerase Chain Reaction
  • RNA, Messenger
  • Prospective Studies
  • Proportional Hazards Models
  • Odds Ratio
  • Myocardial Revascularization
  • Middle Aged
 

Citation

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Voora, D., Coles, A., Lee, K. L., Hoffmann, U., Wingrove, J. A., Rhees, B., … Douglas, P. S. (2017). An age- and sex-specific gene expression score is associated with revascularization and coronary artery disease: Insights from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. Am Heart J, 184, 133–140. https://doi.org/10.1016/j.ahj.2016.11.004
Voora, Deepak, Adrian Coles, Kerry L. Lee, Udo Hoffmann, James A. Wingrove, Brian Rhees, Lin Huang, et al. “An age- and sex-specific gene expression score is associated with revascularization and coronary artery disease: Insights from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial.Am Heart J 184 (February 2017): 133–40. https://doi.org/10.1016/j.ahj.2016.11.004.
Voora D, Coles A, Lee KL, Hoffmann U, Wingrove JA, Rhees B, Huang L, Daniels SE, Monane M, Rosenberg S, Shah SH, Kraus WE, Ginsburg GS, Douglas PS. An age- and sex-specific gene expression score is associated with revascularization and coronary artery disease: Insights from the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial. Am Heart J. 2017 Feb;184:133–140.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2017

Volume

184

Start / End Page

133 / 140

Location

United States

Related Subject Headings

  • Transcriptome
  • Sex Factors
  • Risk Assessment
  • Real-Time Polymerase Chain Reaction
  • RNA, Messenger
  • Prospective Studies
  • Proportional Hazards Models
  • Odds Ratio
  • Myocardial Revascularization
  • Middle Aged