Biomarker Levels and Benefits of Chronic Total Occlusion Revascularization Open Access

Abstract

Background

The survival benefit of revascularization of chronic total occlusion (CTO) of the coronary arteries remains a subject of controversy. We measured high sensitivity troponin‐I (hsTn‐I) levels and N terminal pro-brain natriuretic peptide (NT pro-BNP) levels in patients with stable coronary artery disease, with the hypothesis that (1) patients with CTO have higher levels of  biomarkers than patients without CTO, (2) biomarker levels will predict adverse cardiovascular events in patients with CTO, and (3) patients with elevated biomarker levels will have a survival benefit from CTO revascularization.

Methods

In 428 patients with stable coronary artery disease and CTO undergoing coronary angiography, adverse event rates were investigated. Cox proportional hazards models and Fine and Gray subdistribution hazard models were performed to determine the association between biomarker level and incident event rates in patients with CTO.

 

Results

 

HsTn‐I levels were higher in patients with compared with those without CTO (median 6.7 versus 5.6 ng/L, P=0.002). NT pro-BNP levels were higher in patients with, compared to those without CTO (median 230.0 vs. 177.7 pg/mL, p ≤0.001). Every doubling of hsTn‐I level was associated with a 19% higher adverse event rate and every doubling of NT pro-BNP level was associated with a 25% higher adverse events rate. CTO revascularization was performed in 28.3% of patients. In patients with a high (>median) hsTn‐I level, CTO revascularization was associated with substantially lower all‐cause mortality (adjusted hazard ratio, 0.26 [95% CI, 0.08–0.88]; P=0.030) compared with those who did not undergo revascularization. In patients with elevated NT pro-BNP levels (> 125 pg/mL), those who underwent CTO revascularization had substantially lower adverse event rates compared to patients without CTO revascularization (adjusted cardiovascular death hazard ratio 0.29, 95% confidence interval (0.09–0.88). In patients with a low biomarker levels, event rates were similar in those with and without CTO revascularization.

Conclusions

Biomarker levels may help identify individuals who benefit from CTO revascularization.

Table of Contents

Manuscript: Page 7 - 20

Supplemental Table 1: Page 25

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About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Medicine and Surgery
Keyword	Coronary artery disease Revascularization Biomarkers
Committee Chair / Thesis Advisor	Jordan Kempker, Emory University
Committee Members	Arshed Quyyumi, Emory University Pratik Sandesara, Emory University

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