Polygenic Risk Score Predicts Sudden Death in Patients With Coronary Disease and Preserved Systolic Function

Roopinder K Sandhu; Jacqueline S Dron; Yunxian Liu; M Vinayaga Moorthy; Neal A Chatterjee; Patrick T Ellinor; Daniel I Chasman; Nancy R Cook; Amit V Khera; Christine M Albert

doi:10.1016/j.jacc.2022.05.049

Polygenic Risk Score Predicts Sudden Death in Patients With Coronary Disease and Preserved Systolic Function

J Am Coll Cardiol. 2022 Aug 30;80(9):873-883. doi: 10.1016/j.jacc.2022.05.049.

Authors

Affiliations

¹ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
² Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA.
³ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
⁴ Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁵ Division of Cardiology, University of Washington, Seattle, Washington, USA.
⁶ Division of Cardiology and Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁷ Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Division of Cardiology and Center for Genomic Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁸ Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. Electronic address: Christine.albert@cshs.org.

Abstract

Background: A familial predisposition to sudden and/or arrhythmic death (SAD) in the setting of coronary artery disease (CAD) exists; however, the genetic basis is poorly understood.

Objectives: The purpose of this study was to determine whether a genome-wide polygenic score for coronary artery disease (GPS_CAD) might have utility in SAD risk stratification in CAD patients without severe systolic dysfunction.

Methods: A previously validated GPS_CAD was generated utilizing genome-wide genotyping in 4,698 PRE-DETERMINE participants of European ancestry with CAD and left ventricular ejection fraction >30%-35%. The population was dichotomized according to top GPS_CAD decile as defined by the general population, and absolute, proportional, and relative risks for SAD and non-SAD were estimated using competing risk analyses.

Results: Over a median follow-up of 8.0 years, participants in the top GPS_CAD decile were at elevated absolute SAD risk (8.0%; 95% CI: 5.1%-12.4% vs 4.8%; 95% CI: 3.3%-7.0%; P = 0.005) and proportional SAD risk (29% vs 16%; P = 0.0003) compared with the remainder. After controlling for left ventricular ejection fraction, clinical factors, and electrocardiogram parameters, the top GPS_CAD decile was associated with SAD (subdistribution HR: 1.77; 95% CI: 1.23-2.54; P = 0.002) but not non-SAD (subdistribution HR: 1.00; 95% CI: 0.80-1.25; P = 0.98) (P for Δ = 0.003). The addition of the top GPS_CAD decile to the multivariable model significantly improved net reclassification indexes (NRIs) (continuous NRI: 14.0%; P = 0.024; and categorical NRI: 6.6%; P = 0.005) but not the C-index (difference in C-index: 0.007; P = 0.143).

Conclusions: Among CAD patients without severe systolic dysfunction, high GPS_CAD specifically predicted SAD and enriched for both absolute and proportional SAD risk, identifying a population who might benefit from defibrillator therapy.

Keywords: coronary artery disease; polygenic risk score; sudden death.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Disease* / genetics
Death, Sudden, Cardiac / epidemiology
Death, Sudden, Cardiac / etiology
Humans
Risk Assessment
Risk Factors
Stroke Volume
Ventricular Function, Left

Abstract

Publication types

MeSH terms

Grants and funding