The cardiac rehabilitation biomarker score predicted 10-year mortality risk reduction from 19.12% to 15.9% post-rehabilitation and predicted MACCE better than Framingham and Reynolds scores.
Does a blood-based biomarker score (CRBS) effectively monitor changes in cardiovascular risk and predict MACCE in patients with CAD undergoing cardiac rehabilitation?
A novel blood-based biomarker score (CRBS) can monitor dynamic changes in cardiovascular risk during cardiac rehabilitation and predict MACCE better than traditional risk scores.
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Abstract Background Continuous risk monitoring of patients with coronary artery disease (CAD) may provide insight into patients’ adherence to medical therapy and heart-healthy lifestyle. Traditional risk scores have limited capacity to reflect lifestyle-dependent risk changes and may not be sensitive enough for early identification of disease worsening. Purpose To evaluate if a blood-based biomarker score can be used to monitor changes in cardiovascular risk in patients with CAD. Methods A longitudinal study of n=528 patients (20% women, 56.1±7 years) with a history of CAD following STEMI/NSTEMI and/or angioplasty and/or percutaneous coronary intervention (PCI) and/or coronary artery bypass graft (CABG) was performed. Patients participated in a controlled, guideline-based phase II cardiac rehabilitation program for 3-4 weeks. Blood sampling and cardiopulmonary exercise testing (CPET) was conducted at three time points: at admission (T0), discharge (T1), and at six months after discharge (T2). The cardiac rehabilitation biomarker score (CRBS) was calculated at each time point, incorporating hsTNI, NT-proBNP, HbA1c, cystatin C, and hsCRP to calculate the individual cardiovascular risk expressed as 10-year mortality risk. Kaplan-Meier curves were generated for high and low risk groups (n=384, follow-up = 523±298 days). The Reynolds and Framingham score were used for comparison. Results With CR, the predicted 10-year mortality risk declined from 19.12±15.14% (T0) to 15.9±13.89% (T1, p0.0001). Men and women showed a comparable reduction, despite men presenting with a higher initial risk (20.29% vs. 14.41%, p0.0001). The CRBS detected higher risks in patients with prior MI, those treated with CABG, and multi-vessel CAD, with significant risk reduction post-CR in each group. Risk reduction occurred across all age groups, with slightly attenuated effects in the youngest (40 years) group (p≤0.0852) group. After CR, slower but continuous risk reduction was observed predominantly in high-risk patients (weekly reduction of 0.19±0.11%). Post-CR (T1) CRBS risk predicted MACCE (p=0.039) while results for the Framingham and Reynolds score were not significant (p=0.059, p=0.29). Of note, the CRBS depended on physical fitness (%reference VO2max), as reduced risk was seen for patients with higher baseline fitness as well as those improving fitness during CR (p≤0.0162). The effect of baseline fitness on risk remained significant even after adjusting for event (MI), intervention (CABG), and disease severity (multi vessel CAD) (p=0.007). Conclusion We provide evidence that a blood-based biomarker score can be used to monitor the risk of CAD patients and the effectiveness of secondary prevention programs including CR and exercise-based lifestyle intervention programs. The score may further be used for stratifying patients according to individual risk profiles and MACCE prediction.
Schmitz et al. (Sat,) reported a other. The cardiac rehabilitation biomarker score predicted 10-year mortality risk reduction from 19.12% to 15.9% post-rehabilitation and predicted MACCE better than Framingham and Reynolds scores.