Introduction/Hypothesis: Cardiac biomarkers are well established diagnostic tools in patients with acute coronary syndrome and myocardial infarction. However there is only limited knowledge about the clinical and prognostic value of cardiac biomarkers in patients with stable coronary artery disease (CAD) with mild and obstructive stenosis. The aim of our study was to investigate a possible association of cardiac and inflammatory plasma biomarkers with the severity of CAD and 10 years survival.
Methods: We used plasma samples of 6995 patients from the LIFE Leipzig Heart study undergoing first coronary angiography (72% males and 28% females). 3800 (78%) male and 1046 (55%) female patients did present angiographically obstructive CAD. Patients with acute myocardial infarction were excluded from analysis. The following biomarkers were analyzed: copeptin, troponinT, CRP, IL-6, NT-proBNP, Lipoprotein(a) and PCSK9. The severity of stable CAD was defined as no lumen stenosis, mild coronary stenosis (<50% stenosis) and obstructive stenosis affecting 1-, 2-, and 3- vessels. Cumulative survival of patients was followed up to approximately 10 years after first coronary angiography.
Results: We observed a significant and differently pronounced increase of the studied biomarkers with the severity of obstructive lesions in stable CHD also after adjusting for cardiovascular risk factors. The 10 years survival was most strongly associated with the copeptin levels at the time of first coronary angiography (OR 1.8; p< 1.5e-27). The first and fourth quartiles of copeptin levels were associated with a cumulative survival of 80% and 30%, respectively. In addition to copeptin, the other biomarkers (with the exception of Lipoprotein(a) and PCSK 9) showed also a significant impact on long term survival.
Conclusion: We show in a large cohort of angiographically assessed patients with stable CAD a strong relationship of cardiac biomarkers with the severity of obstructive CAD. Copeptin levels had the highest impact among all biomarkers studied on the cumulative 10 years survival. Our results demonstrate the potential clinical value of cardiac biomarkers to estimate the severity of CAD and the impact of long term survival in stable CHD patients.