Biomarkers for Non-Invasive Stratification of Coronary Artery Disease and Prognostic Impact on Long-Term Survival in Patients with Stable Coronary Heart Disease

Abstract

Knowledge about cardiac and inflammatory biomarkers in patients with stable coronary artery disease (CAD) is limited. To address this, we analyzed 3072 patients (36% female) with a median follow-up of 10 years in the Leipzig LIFE Heart Study with suspected CAD with coronary angiography. Selected biomarkers included troponin T (hsTNT), N-terminal pro B-type natriuretic peptide (NT-proBNP), copeptin, C-reactive protein (hsCRP), and interleukin-6 (IL-6). Patients were stratified by CAD severity: CAD0 (no sclerosis), CAD1 (non-obstructive, i.e., stenosis < 50%), and CAD2 (≥one stenosis ≥ 50%). Group comparison (GC) included GC1: CAD0 + 1 vs. CAD2; GC2: CAD0 vs. CAD1 + 2. CAD0, CAD1, and CAD2 were apparent in 1271, 631, and 1170 patients, respectively. Adjusted for classical risk factors, hs-cTnT, NT-proBNP, and IL-6 differed significantly in both GC and hsCRP only in GC2. After multivariate analysis, hs-cTnT, NT-proBNP, and IL-6 remained significant in GC1. In GC2, hs-cTnT (p < 0.001) and copeptin (p = 0.014) reached significance. Ten-year survival in groups CAD0, CAD1, and CAD2 was 88.3%, 77.3%, and 72.4%. Incorporation of hs-cTnT, NT-proBNP, copeptin, and IL-6 improved risk prediction (p < 0.001). The studied cardiac and inflammatory biomarkers enable fast and precise non-invasive identification of mortality risk in CAD patients, allowing the tailoring of primary and secondary CAD prevention.

Circulating biomarkers in the setting of stress test-induced myocardial ischemia – a review of potential candidates for introduction into clinical practice

“…Biomarkers improve prediction of long-term mortality in CAD patients when compared to established risk prediction algorithms and might allow more accurate classification of patients with stable CAD, enabling physicians to choose more personalized treatment regimens for their patients [43,44]. Incorporation of cardiac troponins, NT-proBNP, copeptin, and IL-6 improved risk prediction in CAD patients even after adjustment for classical risk factors [45]. Biomarkers of endothelial dysfunction and inflammation are promising targets for preventive or therapeutic strategies aimed at protecting the endothelium or reversing endothelial damage in CAD and related complications [46].…”

Postmortem Alteration of Purine Metabolism in Coronary Artery Disease

“…There have been numerous attempts to identify reliable markers of coronary artery disease using molecular techniques. Troponin-T, troponin-I, and high-sensitivity troponin-T [10] are the most accurate markers in cardiovascular patients. Postmortem research has shown that troponin-T is not a specific marker for acute myocardial injury [11].…”