Markers of cell death and formation of neutrophil extracellular traps (NETs) are independently associated with coronary artery disease (CAD) severity and occurrence of adverse cardiac events, according to a study published July 1 inArteriosclerosis, Thrombosis, and Vascular Biology. A novel combination of these biomarkers could potentially aid in the prediction of cardiovascular risk in patients presenting with chest discomfort, the authors say. Data were analyzed from 282 patients (median age 60 years) with nonacute chest discomfort and suspected CAD who were referred for outpatient cardiology evaluations. Coronary computed tomographic angiography (CCTA) was used to assess atherosclerosis, while in vivo markers of atherosclerosis progression (plaque and thrombotic debris, cellular constituents from the vessel wall, and cell types associated with inflammatory processes) were analyzed in blood. Patients with severe CAD or abundant coronary artery calcification had significantly greater circulating extracellular double-stranded DNA (dsDNA) compared to individuals with no angiographically detected CAD. High plasma nucleosome levels were significantly independently associated with more than a two-times increased risk of severe coronary stenosis. The number of atherosclerotic coronary vessels and the occurrence of major adverse cardiac events were also independently predicted by markers of NETs, including MPO-DNA complexes. Finally, increased baseline levels of circulating dsDNA, […]
Markers of cell death and formation of neutrophil extracellular traps (NETs) are independently associated with coronary artery disease (CAD) severity and occurrence of adverse cardiac events, according to a study published July 1 inArteriosclerosis, Thrombosis, and Vascular Biology. A novel combination of these biomarkers could potentially aid in the prediction of cardiovascular risk in patients presenting with chest discomfort, the authors say.
Data were analyzed from 282 patients (median age 60 years) with nonacute chest discomfort and suspected CAD who were referred for outpatient cardiology evaluations. Coronary computed tomographic angiography (CCTA) was used to assess atherosclerosis, while in vivo markers of atherosclerosis progression (plaque and thrombotic debris, cellular constituents from the vessel wall, and cell types associated with inflammatory processes) were analyzed in blood.
Patients with severe CAD or abundant coronary artery calcification had significantly greater circulating extracellular double-stranded DNA (dsDNA) compared to individuals with no angiographically detected CAD. High plasma nucleosome levels were significantly independently associated with more than a two-times increased risk of severe coronary stenosis. The number of atherosclerotic coronary vessels and the occurrence of major adverse cardiac events were also independently predicted by markers of NETs, including MPO-DNA complexes. Finally, increased baseline levels of circulating dsDNA, nucleosomes, and markers of NETosis were significantly associated with the occurrence of major adverse cardiac events (MACE) during follow-up.
“These novel biomarkers could potentially aid in the prediction of MACE in patients with chest discomfort,” write the authors, led by Julian Borissoff, M.D., Ph.D., Harvard Medical School (Boston). “Since some of these biomarkers are inexpensive and technically simple to determine, a broader role might be considered even prior to CCTA, if proven useful as diagnostic and prognostic tools.”
If the markers do pan out, they have the potential to help doctors more efficiently identify which patients with chest pain are likely to have CAD, Borissoff said, possibly minimizing the currently used, time-consuming, and costly battery of tests.
Takeaway: With further proof, a novel combination of extracellular DNA, indicators of cell death, and inflammatory markers may form the basis of a new test capable of identifying chest pain patients at highest risk for clinically significant CAD. Clinical use of such a test has potential value in its ability to more rapidly and cost-effectively identify patients in need of further work-up or intervention.
