Biohumoral predictors of coronary atherosclerosis progression in patients with suspected coronary artery disease from the SMARTool Study

Background: The SMARTool study aims to build a multiparametric predictive model of coronary atherosclerosis (ATS) progression in a population of patients (pts) with suspected coronary artery disease (CAD).

Purpose: This analysis is aimed to assess the role of metabolic and inflammatory biomarkers as determinants of coronary ATS progression in the SMARTool population.

Methods: In 257 pts with suspected CAD, blood sampling and CT coronary angiography (CTCA) were performed at enrollment and after 6±1yrs. In this period 49 pts underwent coronary revascularization and were excluded. Circulating biomarkers and CTCA were evaluated in CoreLabs. Coronary ATS was defined by the presence of detectable plaques in at least one of 17 segments and ATS formation/progression by an increase in total N of plaques at follow-up. Obstructive plaques were defined as causing >50% lumen stenosis at CTCA.

Results: Of the 208 pts included (61±8yrs,119males), 157 had coronary plaques (obstructive in 36). At follow-up, 108 pts had ATS formation/progression (N plaque from 3.3 to 5.3,P<0.0001,obstructive in 19), 64 pts had no ATS progression (N plaque from 4.5 to 4.3,P=0.0063,obstructive in 22) and 36 pts had persistently normal vessels. Biomarkers assessed at baseline and follow-up are compared among the three groups in Table1. At multivariate analysis, after correction for age, gender, risk factors, and drug treatment, ATS formation/progression was not related with any biomarkers at enrollment but was independently related with high IL6 at follow-up (OR 8.02,95% CI 1.03-62.34,p=0.046). Interestingly, only pts with ATS formation/progression had significant increase of IL6, despite a similar frequency of statin treatment (83% and 73%) and LDL reduction in ATS pts, without or with ATS formation/progression (Figure 1).