Key takeaways:

• Patients with a high CAD polygenic risk score who underwent PCI or CABG had an elevated risk of repeat revascularization.
• The CAD polygenic risk score could be used to help guide treatment in the future.

In patients who underwent coronary revascularization, those with a high risk score for coronary artery disease had elevated odds of repeat revascularization or CV death compared with those with a low score, researchers reported.

“Even after successful coronary revascularization, patients with severe CAD remain at risk for recurrent events and repeat procedures,” Arman Qamar, MD, MPH, director of the Center for Cardiovascular Personalized Medicine in the section of interventional cardiology at Endeavor Health in Glenview, Illinois, told Healio. “We wanted to determine whether inherited genetic risk, captured by a CAD polygenic risk score, could help identify residual risk after percutaneous coronary intervention or coronary artery bypass grafting.”

Patients with a high CAD polygenic risk score who underwent PCI or CABG had an elevated risk of repeat revascularization. Image: Adobe Stock

For the retrospective analysis, published in the American Journal of Preventive Cardiology, Qamar and colleagues identified 11,932 participants from the UK Biobank who underwent coronary revascularization between March 2006 and June 2023. Participants were stratified into three groups: those with a low (bottom 20%) CAD polygenic risk score (mean age at revascularization, 68.2 years; 20.4% women), those with a medium (middle 60%) CAD polygenic risk score (mean age at revascularization, 66.9 years; 24.4% women) and those with a high (top 20%) CAD polygenic risk score (mean age at revascularization, 65.5 years; 30.9% women).

The outcomes of interest were CV mortality, repeat coronary revascularization, nonfatal ischemic stroke and all-cause mortality.

In an analysis adjusted for age at revascularization and sex, compared with the low-risk group, the high-risk group had elevated risk for CV mortality (adjusted HR = 1.33; 95% CI, 1.09-1.63; P = .01) and repeat revascularization (aHR = 1.72; 95% CI, 1.39-2.14; P < .001) and the intermediate-risk group had elevated risk for repeat revascularization (aHR = 1.31; 95% CI, 1.09-1.59), the researchers found. There were no differences between the groups in nonfatal ischemic stroke or all-cause mortality.
P < .001), according to the researchers.

The trends were similar between those who had PCI and those who had CABG, the researchers wrote.

“The overall direction of the findings was expected, but the strength and consistency of the association with repeat revascularization were notable,” Qamar told Healio.

The CAD polygenic risk score is not something that can be used alone to guide individual treatment decisions, but “in the future, it could potentially complement traditional risk factors to identify patients who may benefit from more intensive risk-factor management or closer surveillance, but prospective studies are needed first,” Qamar told Healio. “In our cardiac catheterization laboratory at the Endeavor Health Cardiovascular Institute, we have already incorporated genomic risk assessment into our cardiovascular secondary prevention efforts, and our experience has been encouraging. We have found it helpful in identifying patients with residual genetic risk and having more personalized conversations around prevention. Our study provides further evidence supporting the potential role of this approach, while prospective studies are still needed to demonstrate improved clinical outcomes.”

For more information:

Arman Qamar, MD, MPH, can be reached at arman.qamar@endeavorhealth.org.