NYTimes: The Right Dose of Exercise for a Longer Life

NYTimes: The Right Dose of Exercise for a Longer Life

NYTimes: The Right Dose of Exercise for a Longer Life
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Blood Test May Help Clinicians Rule Out CAD in Women

Source URL: http://www.medscape.com/viewarticle/842816

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Blood Test May Help Clinicians Rule Out CAD in Women

Deborah Brauser
April 08, 2015

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Gene Expression Test May Shorten
Coronary Disease Workup

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CLEVELAND, OH The age/sex/gene-expression score (ASGES) test

known as Corus CAD (CardioDx) appears easy to incorporate and effective
in excluding obstructive coronary artery disease (CAD) in middle-aged
women with chest painssaving them from having to undergo further, and
possibly invasive, testing, new research suggests[1].
Combined analysis of more than 300 women from the Investigation of a
Molecular Personalized Coronary Gene Expression Test on Primary Care
Practice Pattern (IMPACT-PCP) and Investigation of a Novel Gene
Expression Test for Diagnosis of Obstructive Coronary Artery Disease
(REGISTRY I) studies who presented to primary care with symptoms
considered "stable yet suggestive of obstructive CAD" showed that those
who had a lower ASGES were significantly less likely to be referred for
further cardiac evaluation than those with an elevated score (P<0.0001).

'Normal' Angiogram Rates for Suspected

CAD Differ Widely

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During follow-up, only one

invasive coronary angiography was performed in a patient with low
ASGES, but no evidence of CAD was found. Three angiographies were
performed among those with high ASGES, resulting in mild CAD diagnosis
in two women and stent placement in the other due to obstructive CAD.
The results were published online March 30, 2015 in Menopause.
"I was surprised at how well healthcare providers translated the test
findings to clinical care," lead author Dr Joseph A Ladapo (New York
University School of Medicine) told heartwire from Medscape.
"We saw a very pronounced difference in rates of referrals for advanced
cardiac testing between women with elevated gene-expression scores and
those with normal scores," he added. "And these findings were consistent
with our safety end points, in terms of the incidence of revascularization or
hospitalization for major cardiovascular events."
Significant Differences in Women
The investigators note that although men and women share symptom
manifestation of CAD and some risk factors, women often present with

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atypical symptoms. "Furthermore, typical symptoms of CAD, such as chest

pain, are more likely to have noncardiac etiologies."

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They add that although current guidelines recommend exercise

electrocardiogram with or without imaging, results from this type of test are
less accurate in women vs men. In addition, coronary angiography, "the
gold standard for identifying anatomic coronary obstructions," is not practical as an initial strategy in women with stable
symptoms because of costs, discomfort, and risk of bleeding and other adverse events.
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Previously reported results from the Coronary Obstruction Detection by Molecular Personalized Gene Expression
(COMPASS) trial showed a 96% negative predictive value for the ASGES test regarding the likelihood of obstructive CAD
in a study population consisting of both men and women[2].
Ladapo noted that his investigative team wanted to evaluate the test in a clinical setting and specifically in women.
"The scientific evidence so far for this test has been great for identifying patients with obstructive heart disease. But it's also
important to demonstrate that healthcare providers use that information in a way that improves patient care," he said.

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Cite this article: Blood Test May Help Clinicians Rule Out CAD in Women. Medscape. Apr 08, 2015.

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