Researchers suggested a blood-based test incorporating age, sex and gene expression score (ASGES) evaluating older outpatients with symptoms indicative of obstructive coronary artery disease (CAD). The researchers have demonstrated that it is more accurate than a cardiac stress test. The findings reported in the Journal of the American Geriatrics Society.

Physicians usually order a cardiac stress test when seeing patients they suspect of having coronary artery disease, but it misdiagnoses many of these patients because it is not a sensitive test. These misdiagnosed patients face higher risks of heart attack and death if they are not treated with the right medications.

The ASGES is a precision medicine test for evaluating these patients, and we have demonstrated that it is more accurate than stress testing for diagnosing coronary artery disease. In the study, the researchers showed that it can be used safely and effectively in older patients, and they are at greatest risk of developing coronary artery disease.

The team analyzed data from a subset of participants in the PRESET registry, a prospective, multicentre observational study that enrolled stable, symptomatic outpatients. The researchers collected information on demographic characteristics, clinical features, ASGES results, pre- and post-ASGES diagnoses, referral patterns, advanced cardiac testing and major adverse cardiac events (MACEs).

The median ASGES score was 25 (range: 1-40), and 23% of participants had a low score. Analysis of the ASGES as a continuous variable showed that the rate of cardiac referral increased proportionally with the score. For every 5-point increase in ASGES, the unadjusted odds of referral were 1.40 times higher in a univariate model.

Dr Fred Fefer, chief, division of cardiology at Long Island Jewish Valley Stream Hospital in New York City observed, "Patients who had low scores had no episodes of cardiac complications, but these patients would likely not have required any sort of non-invasive testing even without the additional blood test."

Patients who did have high composite scores ended up getting either a clinically significant cardiac event or a catheterization, but the study does not separate how many got either. In fact, putting the two groups together probably allows the study's apparent impact to be larger than it would otherwise be.

It seems likely that patients who have chronic complaints of chest pain would end up with a revascularization procedure, not for risk stratification, but for the alleviation of their symptoms. This issue exists irrespective of their clinical scoring.

The ASGES is a potential tool for assessing CAD risk in adults 65 or older, but it is not ready for use in clinical practice. The study compared ASGES to stress testing; we have other tools, such as CT calcium scores, that help to predict risk for heart attacks. Future studies might compare the ASGES with existing tests used to assess cardiovascular risk, Dr Nieca Goldberg suggested.