A gender-specific blood-based gene expression score for assessing obstructive coronary artery disease in nondiabetic patients: Results of the Personalized Risk Evaluation and Diagnosis in the Coronary Tree (PREDICT) Trial
A gender-specific blood-based gene expression score for assessing obstructive coronary artery disease in nondiabetic patients: Results of the Personalized Risk Evaluation and Diagnosis in the Coronary Tree (PREDICT) Trial
复制标题
DOI：
10.1016/j.ahj.2012.05.012
复制
发表时间：
2012-09-01
影响因子：
4.8
通讯作者：
Topol, Eric J.
中科院分区：
文献类型：
--
作者：
Lansky, Alexandra;Elashoff, Michael R.;Topol, Eric J.
背景目前可用的非侵入性检查对阻塞性冠心病患者进行风险分层，导致许多不必要的心脏导管插入术，特别是在女性中。我们试图比较表现症状的诊断准确性，非侵入性测试结果，和基因表达评分（GES）在识别阻塞性冠状动脉疾病（CAD）根据性别，使用定量冠状动脉造影作为标准standard.Methods的预测试验是一个前瞻性的多中心观察性研究，旨在开发和验证基因表达算法，以评估阻塞性CAD，定义为通过定量冠状动脉造影术测量的至少一处直径狭窄≥ 50%。入选了疑似但既往未知CAD的诊断性心导管插入术患者。60%的患者可进行无创心肌灌注成像（MPI）。GES，包括性别特异性年龄功能和6个基因表达术语，包含23个基因，为所有patients.Results共1,160例连续患者（57.6%的男性和42.4%的女性）参加了PREDICT。阻塞性CAD的患病率男性为46.7%，女性为22.0%。胸痛症状是男性阻塞性冠心病的危险因素（P <0.001），但女性不是.男性MPI阳性预测值（45%）显著高于女性（22%）。一个异常的现场读取MPI与阻塞性或严重程度的CAD没有显着相关性。GES每增加10分，阻塞性CAD的几率增加2倍，并且与CAD严重程度和负担的所有指标显著相关。通过多变量分析，GES是总体人群中阻塞性CAD的独立预测因子（比值比[OR] 2.53，P =.001），男性中（OR 1.99，P =.001）和女性（OR 3.45，P = 0.001）分别为亚组，结论在诊断冠心病时，常用的诊断方法包括症状评估和MPI在女性中的表现不如男性。相比之下，性别特异性GES在女性和男性中的表现相似。基因表达评分为非糖尿病患者，特别是疑似梗阻性CAD的女性患者的评估提供了一种可靠的诊断方法。(Am Heart J 2012; 164：320 - 6.）
Background Currently available noninvasive tests to risk stratify patients for obstructive coronary disease result in many unnecessary cardiac catheterizations, especially in women. We sought to compare the diagnostic accuracy of presenting symptoms, noninvasive test results, and a gene expression score (GES) in identifying obstructive coronary artery disease (CAD) according to gender, using quantitative coronary angiography as the criterion standard.Methods The PREDICT trial is a prospective multicenter observational study designed to develop and validate gene expression algorithms to assess obstructive CAD, defined as at least one >= 50% diameter stenosis measured by quantitative coronary angiography. Patients referred for diagnostic cardiac catheterization with suspected but previously unknown CAD were enrolled. Noninvasive myocardial perfusion imaging (MPI) was available in 60% of patients. The GES, comprising gender-specific age functions and 6 gene expression terms containing 23 genes, was performed for all patients.Results A total of 1,160 consecutive patients (57.6% men and 42.4% women) were enrolled in PREDICT. The prevalence of obstructive CAD was 46.7% in men and 22.0% in women. Chest pain symptoms were a discriminator of obstructive CAD in men (P < .001) but not in women. The positive predictive value of MPI was significantly higher in men (45%) than in women (22%). An abnormal site-read MPI was not significantly associated with obstructive or severity of CAD. The GES was significantly associated with a 2-fold increase in the odds of obstructive CAD for every 10-point increment in the GES and had a significant association with all measures of severity and burden of CAD. By multivariable analysis, GES was an independent predictor of obstructive CAD in the overall population (odds ratio [OR] 2.53, P = .001) and in the male (OR 1.99, P = .001) and female (OR 3.45, P = .001) subgroups separately, whereas MPI was not.Conclusions Commonly used diagnostic approaches including symptom evaluation and MPI performed less well in women than in men for identifying significant CAD. In contrast, gender-specific GES performed similarly in women and men. Gene expression score offers a reliable diagnostic approach for the assessment of nondiabetic patients and, in particular, women with suspected obstructive CAD. (Am Heart J 2012;164:320-6.)