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. 2024 Aug 26;25(9):1197-1205.
doi: 10.1093/ehjci/jeae093.

Combining anatomical and biochemical markers in the detection and risk stratification of coronary artery disease

Miriam Albus  1   2 , Tobias Zimmermann  1   3 , Daniela Median  1 , Klara Rumora  1 , Ganna Isayeva  1 , Melissa Amrein  1 , Ibrahim Schaefer  1   2 , Joan Walter  1   4 , Evita Michel  1 , Gabrielle Huré  1 , Ivo Strebel  1 , Federico Caobelli  5 , Philip Haaf  1 , Simon M Frey  1 , Christian Mueller  1 , Michael J Zellweger  1
Affiliations

Combining anatomical and biochemical markers in the detection and risk stratification of coronary artery disease

Miriam Albus et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: We aimed to test the hypothesis if combining coronary artery calcium score (Ca-score) as a quantitative anatomical marker of coronary atherosclerosis with high-sensitivity cardiac troponin as a quantitative biochemical marker of myocardial injury provided incremental value in the detection of functionally relevant coronary artery disease (fCAD) and risk stratification.

Methods and results: Consecutive patients undergoing myocardial perfusion single-photon emission computed tomography (MPS) without prior CAD were enrolled. The diagnosis of fCAD was based on the presence of ischaemia on MPS and coronary angiography; fCAD was centrally adjudicated in the diagnostic and prognostic domain. Diagnostic accuracy was evaluated using the area under the receiver-operating characteristic curve (AUC). The composite of cardiovascular death and non-fatal acute myocardial infarction (AMI) within 730 days was the primary prognostic endpoint. Among 1715 patients eligible for the diagnostic analysis, 399 patients had fCAD. The combination of Ca-score and high-sensitivity cardiac troponin T (hs-cTnT) had good diagnostic accuracy for the diagnosis of fCAD (AUC 0.79, 95% confidence interval (CI) 0.77-0.81), but no incremental value compared with the Ca-score alone (AUC 0.79, 95% CI 0.77-0.81, P = 0.965). Similar results were observed using high-sensitivity cardiac troponin I (AUC 0.80, 95% CI 0.77-0.82) instead of hs-cTnT. Among 1709 patients (99.7%) with available follow-up, 59 patients (3.5%) suffered the composite primary prognostic endpoint (non-fatal AMI, n = 34; CV death, n = 28). Both Ca-score and hs-cTnT had independent prognostic value. Increased risk was restricted to patients with elevation in both markers.

Conclusion: The combination of the Ca-score with hs-cTnT increases the prognostic accuracy for future events but does not provide incremental value vs. the Ca-score alone for the diagnosis of fCAD.

Study registration: Clinical trial registration: NCT00470587.

Keywords: Agatston score; calcium score; coronary artery disease; high-sensitivity cardiac troponin; myocardial ischaemia; myocardial perfusion SPECT; prognosis.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Diagnostic accuracy of calcium score, hs-TnT, and a combination of calcium score and hs-TnT, quantified by AUC.
Figure 2
Figure 2
Kaplan–Meier curve for primary endpoint (cardiovascular death, AMI). Groups classified by calcium score (CS) and hs-cTnT below (−) and above (+) the cut of value (cut of value CS < 100; cut of value hs-cTnT < 14 ng/L).
Figure 3
Figure 3
Kaplan–Meier curve for secondary endpoint 1 (all-cause death). Groups classified by calcium score (CS) and hs-cTnT below (−) and above (+) the cut of value (cut of value CS < 100; cut of value hs-cTnT < 14 ng/L).
See this image and copyright information in PMC

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