TY - JOUR
T1 - Prognostic value of urinary 11-dehydro-thromboxane B2 for mortality
T2 - A cohort study of stable coronary artery disease patients treated with aspirin
AU - Vasudevan, Anupama
AU - Tecson, Kristen M.
AU - Bennett-Firmin, Jeanna
AU - Bottiglieri, Teodoro
AU - Lopez, Luis R.
AU - Peterson, Margarita
AU - Sathyamoorthy, Mohanakrishnan
AU - Schiffmann, Raphael
AU - Schussler, Jeffrey M.
AU - Swift, Caren
AU - Velasco, Carlos E
AU - McCullough, Peter A.
N1 - Funding Information:
Analyses were conducted using STATA 14.2. Baseline variables are presented as means/medians for continuous variables and proportions for categorical variables. Chi-square/Fisher's exact tests were employed to compare proportions and Wilcoxon rank-sum/Student t-tests for continuous variables as appropriate. For the analysis, we utilized the natural-log transformation of 11dhTxB2 for the receiver operating characteristic (ROC) curve analysis in order to reduce the variability of the data. We assessed the ability of baseline urinary 11dhTxB2 to predict mortality by creating an ROC curve and calculating the area under the curve (AUC). The optimal cut point was then calculated based on the distance to (0, 1), where Distance to 0,1= 1−Sensitivity2+1−Specificity2 By this method, the point closest to the upper-left corner where 1-Specificity = 0 and Sensitivity = 1 was identified. To determine the confidence interval (CI) for the optimal cut point, boot strapping was done with 500 resampling simulations. Likelihood ratios (LR) were then calculated based on the sensitivity and specificity of the optimal cut point. The antilog transformation was performed on the optimal cut point to determine the urinary 11dhTxB2 value for clinical use. After identification of the optimal cut point, we calculated full decision statistics for the outcome of all-cause mortality as the outcome. A multivariable logistic regression analysis for the outcome of mortality was then constructed including the demographic and clinical variables with a P-value of <0.1. We categorized urinary 11dhTxB2 based on the optimal cut point identified in our data and included it as an independent variable in the prediction model. The AUC of this model was then calculated. This study was approved by the Baylor Health Care System institutional review board and conforms to the ethical guidelines of the 1975 Declaration of Helsinki. This study was supported in part by Corgenix and by the Baylor Health Care System Foundation
Publisher Copyright:
© 2017 Wiley Periodicals, Inc.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Aim: There is a variable cardiovascular risk reduction attributable to aspirin because of individual differences in the suppression of thromboxane A2 and its downstream metabolite 11-dehydro-thromboxane B2 (11dhTxB2). The aim of this study is to evaluate the optimal cut point of urinary 11dhTxB2 for the risk of mortality in aspirin-treated coronary artery disease (CAD) patients. Methods and Results: This was a prospective cohort study including stable CAD patients who visited the Baylor Heart and Vascular Hospital in Dallas or the Texas Heart Hospital Baylor Plano, TX between 2010 and 2013. The outcome of all-cause mortality was ascertained from chart review and automated sources. The 449 patients included in this analysis had a mean age of 66.1 ± 10.1 years. 67 (14.9%) patients died within 5 years; 56 (87.5%) of the 64 patients with known cause of death suffered a cardiovascular related mortality. Baseline ln(urinary 11dhTxB2/creatinine) ranged between 5.8 and 11.1 (median = 7.2) with the higher concentrations among those who died (median: 7.6) than those who survived (median = 7.2, P < 0.001). Using baseline ln(11dhTxB2) to predict all-cause mortality, the area under the curve was 0.70 (95% CI: 0.64–0.76). The optimal cut point was found to be ln(7.38) = 1597.8 pg/mg, which had the following decision statistics: sensitivity = 0.67, specificity = 0.62, positive predictive value = 0.24, negative predictive value = 0.92, and accuracy = 0.63. Conclusion: Our data indicate the optimal cut point for urine 11dhTxB2 is 1597.8 (pg/mg) for the risk prediction of mortality over five years in stable patients with CAD patients treated with aspirin.
AB - Aim: There is a variable cardiovascular risk reduction attributable to aspirin because of individual differences in the suppression of thromboxane A2 and its downstream metabolite 11-dehydro-thromboxane B2 (11dhTxB2). The aim of this study is to evaluate the optimal cut point of urinary 11dhTxB2 for the risk of mortality in aspirin-treated coronary artery disease (CAD) patients. Methods and Results: This was a prospective cohort study including stable CAD patients who visited the Baylor Heart and Vascular Hospital in Dallas or the Texas Heart Hospital Baylor Plano, TX between 2010 and 2013. The outcome of all-cause mortality was ascertained from chart review and automated sources. The 449 patients included in this analysis had a mean age of 66.1 ± 10.1 years. 67 (14.9%) patients died within 5 years; 56 (87.5%) of the 64 patients with known cause of death suffered a cardiovascular related mortality. Baseline ln(urinary 11dhTxB2/creatinine) ranged between 5.8 and 11.1 (median = 7.2) with the higher concentrations among those who died (median: 7.6) than those who survived (median = 7.2, P < 0.001). Using baseline ln(11dhTxB2) to predict all-cause mortality, the area under the curve was 0.70 (95% CI: 0.64–0.76). The optimal cut point was found to be ln(7.38) = 1597.8 pg/mg, which had the following decision statistics: sensitivity = 0.67, specificity = 0.62, positive predictive value = 0.24, negative predictive value = 0.92, and accuracy = 0.63. Conclusion: Our data indicate the optimal cut point for urine 11dhTxB2 is 1597.8 (pg/mg) for the risk prediction of mortality over five years in stable patients with CAD patients treated with aspirin.
KW - aspirin
KW - cad
KW - cut point
KW - mortality
KW - sensitivity
UR - http://www.scopus.com/inward/record.url?scp=85046742921&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85046742921&partnerID=8YFLogxK
U2 - 10.1002/ccd.27437
DO - 10.1002/ccd.27437
M3 - Article
C2 - 29193683
AN - SCOPUS:85046742921
SN - 1522-1946
VL - 92
SP - 653
EP - 658
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 4
ER -