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Utility of a Precision Medicine Test in Elderly Adults with Symptoms Suggestive of Coronary Artery Disease
Author(s) -
Ladapo Joseph A.,
Budoff Matthew J.,
Sharp David,
Kuo Jane Z.,
Huang Lin,
Maniet Bruce,
Herman Lee,
Monane Mark
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15215
Subject(s) - medicine , mace , coronary artery disease , referral , incidence (geometry) , odds ratio , revascularization , myocardial infarction , physical therapy , emergency medicine , cardiology , family medicine , percutaneous coronary intervention , physics , optics
Background Diagnosing obstructive coronary artery disease ( CAD ) is challenging in elderly adults, and current diagnostic approaches for CAD expose these individuals to risks from contrast dye and invasive procedures. Design A Registry to Evaluate Patterns of Care Associated with the Use of Corus CAD in Real World Clinical Care Settings ( PRESET ; NCT 01677156), pragmatic clinical trial. Setting Community, 21 primary care practices. Participants Of 566 stable, nonacute outpatients presenting with symptoms suggestive of obstructive CAD , the 176 who were aged 65 and older (median age 70, 61% female) were the current study participants. Intervention Blood‐based precision medicine test, incorporating age, sex, and gene expression score ( ASGES ) to improve clinical decision‐making and quality of care. Measurements Information on demographic characteristics, clinical factors, ASGES results (range 1–40; low (≤15), high (>15)), referral patterns to cardiology and advanced cardiac testing, and major adverse cardiac events ( MACE s) was collected in a subgroup analysis of elderly adults in the PRESET Registry. Follow‐up was for 1 year after ASGES testing. Results Median ASGES was 25, and 40 (23%) participants had a low score. Clinicians referred 12.5% of participants with a low ASGES and 49.3% with a high ASGES to cardiology or advanced cardiac testing (odds ratio for referral = 0.12, P < .001, adjusted for participants demographics and clinical covariates). Higher scores were associated with greater likelihood of posttest cardiac referral. At 1‐year follow‐up, the incidence of a MACE or revascularization was 10% (13/136) in the high ASGES group and 0% (0/40) in the low ASGES group ( P = .04). Conclusion The ASGES test showed potential clinical utility in the evaluation of elderly outpatients with symptoms suggestive of obstructive CAD . Test use may reduce unnecessary referrals and the risk of procedure‐related complications in individuals with low ASGES , who are unlikely to benefit from further testing, while also identifying individuals who may benefit from further cardiac evaluation and management.