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Quantitative test risk-stratifies elderly patients with possible CAD
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An age, sex and gene expression score, or ASGES, can be used to assess older patients with symptoms of obstructive CAD, which may reduce the risk for procedure-related complications and unnecessary referrals, according to a study published in the Journal of the American Geriatrics Society.
“Overall, ASGES is an innovation in diagnostic technology for obstructive CAD that appears to be similarly effective in older and younger adults,” Joseph A. Ladapo, MD, PhD, associate professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, and colleagues wrote.
Researchers analyzed data from 176 patients (median age, 70 years; 61% women) aged at least 65 years from the PRESET registry who had nonacute chest pain and symptoms of nonobstructive CAD. Patients were excluded for criteria such as a history of revascularization or MI, diabetes, high-risk unstable angina and HF symptoms.
The age, sex and gene expression test (Corus CAD, CardioDx) used in vitro blood to generate an algorithmic score with a gene expression profile, which is then combined with a patient’s age and sex. The score, which ranges from 1 to 40, is used to assess the probability of a patient having obstructive CAD. Higher scores are associated with the likelihood of obstructive CAD.
Patients were followed up for 1 year for major adverse CV events, defined as MI, stroke, revascularization or cardiac-related hospitalization or death.
The primary outcome was to evaluate the link between the score and cardiac referral, defined as referral for advanced cardiac testing or cardiology within 45 days of the test.
The median score was 25, and 23% of patients had low scores.
Patients with high scores (49.3%) were more likely to be referred for cardiology or advanced cardiac testing compared with those with lower scores (12.5%), which remained statistically significant after adjusting for clinical covariates and demographics (OR = 0.12; P < .001). The rate of patients who were received a cardiac referral increased with the score.
At 1 year, 10% of patients with high scores underwent revascularization or had a major cardiac event vs. none of the patients with low scores (P = .04).
“Test use may reduce unnecessary referrals and the risk of procedure-related complications in individuals with low scores while also identifying individuals who may benefit from further cardiac evaluation and management because the referral pattern as a function of the ASGES closely parallels the current likelihood of obstructive CAD as a function of the ASGES,” Ladapo and colleagues wrote. – by Darlene Dobkowski
Disclosures: The study was funded by CardioDx. Ladapo reports he receives honoraria, consulting fees and research support from CardioDx. Please see the study for all other authors’ relevant financial disclosures.
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