Abstract 16083: Aggregate Risk Score Based on Markers of Inflammation, Immunity, and Thrombosis is an Independent Predictor of Adverse Cardiovascular Outcomes
Introduction: Activation of diverse pathophysiologic processes that include inflammatory, thrombotic, and immune pathways, contribute to the development of CAD, subsequent plaque rupture and adverse outcomes. We hypothesized that an aggregate biomarker risk score comprised of C-reactive protein (CRP), fibrin degradation products (FDP), cytomegalovirus antibody (CMV Ab), Heat Shock Protein 70 (HSP70), and antibody to Heat Shock Protein 60 (anti-HSP60) would provide better assessment of future risk of adverse events.
Methods: 1500 subjects were selected in a case-control study from the Emory Cardiology Biobank, a registry of patients undergoing cardiac catheterization. 500 subjects in each group included those 1) with angiographic CAD who suffered death or MI at 2 years of follow-up; 2) with angiographic CAD with no MI or death; 3) with no CAD. Groups were matched for cardiovascular risk factors using propensity scoring. Plasma biomarkers were measured using ELISA (Genway® Inc). Cox proportional hazard survival analyses were performed with models further adjusted for age, BMI, sex, race, smoking, diabetes, and hypertension. Data were analyzed as continuous variables and with cut points assigned based on accepted values.
Results: For primary outcomes of death and MI at two years, modeling with cut points revealed hazard ratios (HR) of 1.89 (p <0.001) for CRP at 3.0 mg/L; HR of 1.42 (p=0.005) for HSP70 when detectable; and HR of 2.04 (p <0.001) for FDP at 1.0 µg/ml. Levels of CMV antibody and anti-HSP60 were not significantly associated with any outcomes. HRs for the primary outcome using categorical risk scores calculated using all 3 significant biomarkers in aggregate were done for 1) individuals being evaluated for possible CAD and 2) subjects with angiographically documented CAD. For analysis 1: HR = 1.68 (p= 0.008) for 1 biomarker positive, 2.64 (p <0.0001) for 2 biomarkers, and 3.76 (p <0.0001) for 3 biomarkers elevated. For analysis 2: HR = 1.75 (p=0.005) for 1 biomarker positive, 2.69 (p<0.0001) for 2 biomarkers, and 3.50 (p<0.0001) for 3 biomarkers.
Conclusions: An aggregate score based on measures of CRP, FDP and HSP70 is a strong predictor of future risk of death and MI in patients being considered for coronary angiography and those with known CAD.
- © 2011 by American Heart Association, Inc.