Combined inflammatory and angiogenic biomarkers predict disease severity and mortality in patients undergoing coronary angiography
B S Yildiz, Y G Demiragci, R Gunduz, S Ozgur, I H Ozdemir, E O Bakir, F Aktas, S Tas, U Tas, M B OzenAbstract
Background
Inflammation, macrophage activation, and angiogenic remodeling play central roles in coronary artery disease (CAD) progression and plaque instability. Biomarkers reflecting these complementary biological pathways may improve risk stratification beyond conventional clinical assessment. We evaluated the combined diagnostic and prognostic significance of chitotriosidase (CHIT), resistin (RTN), and vascular endothelial growth factor-A (VEGF-A) in patients undergoing coronary angiography.
Methods
In this prospective observational cohort, 275 consecutive patients undergoing coronary angiography were categorized as normal coronary arteries or CAD, including stable angina pectoris (SAP), unstable angina pectoris (UAP), non–ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). Serum CHIT, RTN, and VEGF-A levels were measured before angiography. Patients were followed for one-year all-cause mortality. Prognostic performance was evaluated using receiver operating characteristic analysis and Cox proportional hazards models.
Results
All biomarkers were significantly higher in CAD compared with controls and demonstrated a progressive increase from SAP to STEMI presentations (p<0.001). ROC analysis showed good discriminatory performance for mortality prediction (AUC: VEGF-A 0.773, CHIT 0.740, Troponin 0.742, RTN 0.703). In multivariable Cox regression analysis, CHIT remained the only independent predictor of adverse outcome (HR 18.8, 95% CI 2.48–142.34, p=0.005). Addition of CHIT significantly improved prognostic discrimination (C-index increase from 0.64 to 0.79; ΔC=0.15, p<0.001). Kaplan–Meier analysis confirmed significantly higher mortality among patients with elevated biomarker levels.
Conclusion
Combined assessment of inflammatory and angiogenic biomarkers reflects biological disease activity across the CAD spectrum and provides incremental prognostic value beyond conventional markers. Multimarker evaluation may enhance individualized risk stratification in patients undergoing coronary angiography.ROC curves for one-year mortalityKaplan–Meier survival by biomarkers