Clinical InvestigationAcute Ischemic Heart DiseaseA 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
Section snippets
Patient selection and definitions
The PREDICT trial is a prospective multicenter observational study designed to develop and validate a gene expression algorithm to assess the likelihood of obstructive CAD.4 Subjects were eligible for enrollment in PREDICT if they were older than 20 years; had a history of chest pain, anginal symptoms suggesting myocardial ischemia, unstable angina, or asymptomatic with a high risk of CAD with no known prior CAD. Patients with known CAD, New York Heart Association class III or IV, left
Results
The development and validation cohorts from the PREDICT trial comprised 1,166 consecutive nondiabetic patients. Coronary angiograms of suitable quality for quantitative analysis were available in 1,160 of the 1,166 patients in these cohorts. Baseline demographics demonstrated that men and women had similar risk factors including age, body mass index, race distribution, and incidence of hypertension and dyslipidemia (Table I). Women were less likely to be on aspirin therapy but more likely to be
Discussion
This study demonstrates that in a contemporary US-based population referred to diagnostic angiography for suspected CAD, only 36.2% of patients and only 22.0% of women had obstructive CAD with a characteristic age-dependent rise in the prevalence of CAD after 60 years of age for women. Although symptoms on presentation were helpful in identifying obstructive CAD in men, symptoms of angina as defined by Diamond and Forrester5 were not helpful in predicting CAD in women. In this population
Conclusion
The use of a blood-based GES may be particularly helpful in the assessment of obstructive CAD in nondiabetic patients and, in particular, women for whom the use of symptoms and functional testing has proven unreliable. Further studies are needed to validate whether this test or other methods that use individualized genomic data will help promote more efficient and appropriate use of coronary angiography in women.
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Cited by (0)
PREDICT: www.clinicaltrials.gov, NCT00500617.
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For the PREDICT investigators