Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome.
A, T., J, N., J, T., H, T., C, S., D, L., T, L., AA, D., S, H., & H, K. (2026). Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.048737
A T, J N, J T, H T, C S, D L, et al. Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome.. Journal of the American Heart Association. 2026; doi: 10.1161/JAHA.125.048737
A T, J N, J T, et al. Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome.[J]. Journal of the American Heart Association. 2026. DOI: 10.1161/JAHA.125.048737.
@article{a2026,
author = {Teren A and Netto J and Thiery J and Thiele H and Stellbrink C and Lawin D and Lawrenz T and Derda AA and Henger S and Kirsten H},
title = {Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome.},
journal = {Journal of the American Heart Association},
year = {2026},
doi = {10.1161/JAHA.125.048737},
note = {PMID: 42216272},
}
TY - JOUR AU - Teren A AU - Netto J AU - Thiery J AU - Thiele H AU - Stellbrink C AU - Lawin D AU - Lawrenz T AU - Derda AA AU - Henger S AU - Kirsten H TI - Cardiac Biomarkers to Refine Pretest Probability for Coronary Obstruction and Predict Survival After Revascularization in Chronic Coronary Syndrome. T2 - Journal of the American Heart Association PY - 2026 DO - 10.1161/JAHA.125.048737 AN - PMID:42216272 ER -
BACKGROUND: The diagnostic and prognostic roles of cardiovascular biomarkers in chronic coronary syndrome remain unclear. METHODS: Patients undergoing coronary angiography for suspected chronic coronary syndrome were prospectively enrolled (n=2251; median follow-up 12.6 years). Obstructive coronary artery disease was defined as ≥50% stenosis in ≥1 major epicardial vessel. HsTnT (high-sensitivity cardiac troponin T), NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity C-reactive protein, interleukin-6, and copeptin were measured. Receiver operating characteristic analysis and Cox regression with biomarker × treatment interaction testing were performed. RESULTS: Overall, 888 patients (39.4%) had obstructive coronary artery disease. Only hsTnT showed meaningful diagnostic capacity (area under the curve 0.669; risk factor-weighted clinical likelihood area under the curve 0.663), with incremental benefit inversely proportional to risk factor-weighted clinical likelihood category (Δ area under the curve: very low 10.4%, low 8.0%, intermediate/high 5.0%). NT-proBNP was the strongest mortality predictor across optimal medical therapy (hazard ratio [HR], 1.488 [95% CI, 1.288-1.720], P<0.001), percutaneous coronary intervention (HR, 1.220 [95% CI, 1.020-1.458], P=0.029), and coronary artery bypass grafting (HR, 1.220 [95% CI, 1.049-1.420], P=0.010). Interaction analysis validated a data-derived 150 pg/mL threshold (P=0.032): below it, mortality was comparably low regardless of revascularization (HR, 0.98 [95% CI, 0.67-1.43], P=0.910); above it, baseline risk was markedly elevated (HR, 5.75 [95% CI, 4.10-8.00], P<0.001) and revascularization associated with 40% mortality reduction, with substantial residual risk (HR, 3.43 [95% CI, 2.70-4.40], P<0.001). CONCLUSIONS: HsTnT provides risk factor-weighted clinical likelihood category-specific incremental diagnostic value. NT-proBNP is a universal prognostic marker identifying patients with distinct revascularization-associated mortality reduction driven by differential baseline risk. REGISTRATION: URL: https://clinicaltrials.gov/study/NCT00497887; Unique Identifier: NCT00497887.