Multimarker Approach for the Prediction of Cardiovascular Events in Patients With Mild to Moderate Coronary Artery Lesions: A 3-Year Follow-Up Study

Few studies have assessed the incremental usefulness of multimarkers as predictors of cardiovascular events in patients with mild to moderate coronary artery lesions. We examined 9 plasma inflammatory cytokines (cathepsin S, CXCL16, sopluble CD40 ligand, interleukin-10, placental growth factor, GDF15, matrix metalloproteinase 9, monocyte chemoattractant protein-1, and high-sensitivity C-reactive protein) in 964 patients showing mild to moderate lesions and assessed their association with risk of cardiovascular events during 3 years of follow-up (median 17 months). In a backward Cox regression procedure, Cystatin S (hazard ratio [HR]: 1.788, 95% CI:1.233 to 2.593, P = 0.02), soluble CD40 ligand (HR: 1.255, 95% CI:1.054 to 1.494, P = 0.011), placental growth factor (HR: 1.194, 95% CI:0.976 to 1.461, P = 0.035), and GDF15 (HR: 0.725, 95% CI:0.550 to 0.956, P = 0.023) were significantly related to cardiovascular events. Compared with multimarker score (according to regression coefficients of significant biomarkers) in the lowest two quintiles, patients in the highest quintile had a higher risk of cardiovascular events after adjustment for traditional risk factors (HR: 2.77, 95% CI:1.30 to 5.87, P = 0.008). Adding the multimarker score to traditional risk factors contributed significantly to the prediction of cardiovascular events (AUC increased from 0.67 to 0.72). A multimarker approach added to the predictive information obtained from traditional risk factors in patients with mild to moderate coronary artery lesions.