Prognostic Value of Cardiovascular Biomarkers for Cardiac Stress Test Results and Adverse Cardiovascular Events in Patients With Suspected Coronary Artery Disease

Cardiovascular biomarkers are established to guide diagnostic and prognostic evaluation in suspected coronary syndrome, but their role in cardiac stress testing remains debated. We evaluated their ability to discriminate positive and negative stress test results and predict major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD). In a prospective cohort study patients undergoing cardiac stress testing for suspected CAD had baseline measurements of high-sensitivity cardiac troponin (hs-cTnI), high-sensitivity C-reactive protein, natriuretic peptides, and growth differentiation factor 15 (GDF-15). Hs-cTnI was remeasured 1 hour post-test. Diagnostic performance for predicting positive stress test results was evaluated using receiver operating characteristic curves and optimal cutoffs determined by Youden's index. Clinical outcomes were ascertained by phone/mail follow-up, hospital records, and verified through the local death registry, with a median follow-up of 2.8 years. Associations with MACE were examined using Cox regression models. Of 765 participants, 234 had positive stress and 531 had negative stress tests. Baseline hs-cTnI, natriuretic peptides, and GDF-15 were higher in pathological cases, but consistent with prior studies, all biomarkers showed poor discrimination for stress test results (area under a receiver-operating-curve < 0.65). Hs-cTnI concentrations slightly decreased after stress testing. During follow-up, 31% experienced MACE. Stress testing alone showed modest prediction of MACE, whereas the addition of hs-cTnI and GDF-15 demonstrated independent predictive value beyond conventional risk factors and stress test results. In conclusion, biomarkers poorly discriminated stress test results, but hs-cTnI and GDF-15 independently predicted incident MACE, suggesting their potential to improve risk stratification in high-risk patients with suspected CAD.