Multiple Biomarkers to Predict Major Adverse Cardiovascular Events in Patients With Coronary Chronic Total Occlusions

There are limited tools available to predict the long-term prognosis of persons with coronary chronic total occlusions (CTO). A previously-described blood biomarker panel to predict cardiovascular (CV) events was evaluated in patients with CTO. From 1251 patients in the CASABLANCA study, 241 participants with a CTO were followed for an average of 4 years for occurrence of major adverse CV events (MACE, CV death, non-fatal myocardial infarction or stroke) and CV death/heart failure (HF) hospitalization. Results of a biomarker panel (kidney injury molecule-1, N-terminal pro-B-type natriuretic peptide, osteopontin, and tissue inhibitor of metalloproteinase-1) from baseline samples were expressed as low-, medium-, and high-risk. By 4 years, a total of 67 (27.8%) MACE and 56 (23.2%) CV death/HF hospitalization events occurred. The C-statistic of the panel for MACE through 4 years was 0.79 (P <0.001). Considering the low-risk group as referent, the hazard ratio (HR) of MACE by 4 years was 6.65 (95% confidence interval [CI]: 2.98-14.8) and 12.4 (95% CI:5.17-29.6) for the medium and high-risk groups (both P <0.001). The C-statistic for CVD/HF hospitalization by 4 years was 0.84 (P <0.001). Compared to the low-risk score group, the medium and high-risk groups had HR of 5.61 (95% CI: 2.33-13.5) and 15.6 (95% CI: 6.18, 39.2; both P value <0.001). In conclusion, a multiple biomarker panel assisted in discriminating a broad range of risk for adverse outcomes in patients with coronary CTO. These results may have implications for risk stratification, patient care and could have a role for clinical trial enrichment.