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J Am Board Fam Med. 2014 Mar-Apr;27(2):258-67. doi: 10.3122/jabfm.2014.02.130155.

Utility of a genomic-based, personalized medicine test in patients presenting with symptoms suggesting coronary artery disease.

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  • 1Johns Creek Primary Care, Suwanee, GA; Family Care Clinic, Bonham, TX; Carolina Family Healthcare, Weddington, NC; The Lipid Center, Baton Rouge, LA; CardioDx, Inc., Palo Alto, CA; and Vanderbilt University, Nashville, TN.

Abstract

PURPOSE:

Better methods are needed to assess patients presenting with symptoms suggestive of obstructive coronary artery disease (CAD). We hypothesized that the use of a gene expression score (GES) would lead to a change in the diagnostic evaluation.

METHODS:

The Primary Care Providers Use of a Gene Expression Test in Coronary Artery Disease Diagnosis (IMPACT-PCP) trial (clinical trial identifier NCT01594411, clinicaltrials.gov) was a prospective study of stable, nonacute, nondiabetic patients presenting with chest pain and related symptoms at 4 primary care practices. All patients underwent GES testing, with clinicians documenting their planned diagnostic strategy both before and after GES. The GES was derived from a peripheral blood draw measuring expression of 23 genes and has been shown to have a 96% negative predictive value for excluding the diagnosis of obstructive CAD.

RESULTS:

Of the 251 study patients, 140 were women (56%); the participants had a mean age of 56 years (standard deviation, 13.0) and a mean body mass index of 30 mg/kg(2) (standard deviation, 6.7). The mean GES was 16 (range, 1-38), and 127 patients (51%) had a low GES ([ltqeu]15). A change in the diagnostic testing pattern before and after GES testing was noted in 145 of 251 patients (58% observed vs. 10% predefined expected change; P < .001).

CONCLUSIONS:

Incorporation of the GES into the diagnostic workup showed clinical utility above and beyond conventional clinical factors by optimizing the patient's diagnostic evaluation.

KEYWORDS:

Cardiovascular Abnormalities; Genetics; Medical Decision Making; Practice-based Research; Technology Assessment

PMID:
24610188
[PubMed - indexed for MEDLINE]
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