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Growth differentiation factor 15 for risk stratification and selection of an invasive treatment strategy in non
Kai C Wollert1, Tibor Kempf, Bo Lagerqvist
1Department of Cardiology and Angiology, Hannover University Medical School, Hannover, Germany.
Insights
Growth Differentiation Factor 15 (GDF-15) levels help stratify risk in non-ST-elevation acute coronary syndrome. High GDF-15 identifies patients who benefit most from an invasive treatment strategy, improving outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Acute Coronary Syndromes
Background:
- Invasive treatment improves outcomes for moderate-to-high risk non-ST-elevation acute coronary syndrome (NSTE-ACS) patients.
- Growth Differentiation Factor 15 (GDF-15) is investigated as a potential biomarker for risk stratification in NSTE-ACS.
Purpose of the Study:
- To evaluate the role of circulating GDF-15 levels in risk stratification for NSTE-ACS.
- To determine if GDF-15 levels influence the effectiveness of invasive versus conservative treatment strategies.
Main Methods:
- Analysis of GDF-15 levels on admission in 2079 NSTE-ACS patients from the FRISC-II trial.
- Correlation of GDF-15 levels with the composite endpoint of death or recurrent myocardial infarction.
- Assessment of treatment strategy interaction with GDF-15 levels.
Main Results:
- Elevated GDF-15 independently predicted risk in the conservative group (P=0.016).
- The invasive strategy significantly reduced the composite endpoint in patients with GDF-15 >1800 ng/L (HR 0.49) and 1200-1800 ng/L (HR 0.68).
- No significant benefit from the invasive strategy was observed for GDF-15 <1200 ng/L.
Conclusions:
- GDF-15 is a potential tool for risk stratification and guiding therapeutic decisions in NSTE-ACS.
- GDF-15 levels may help identify patients who benefit from an invasive strategy.
- Further prospective randomized trials are needed to validate these findings.
Background:
An invasive treatment strategy improves outcome in patients with non-ST-elevation acute coronary syndrome at moderate to high risk. We hypothesized that the circulating level of growth differentiation factor 15 (GDF-15) may improve risk stratification.
Methods And Results:
The Fast Revascularization during InStability in Coronary artery disease II (FRISC-II) trial randomized patients with non-ST-elevation acute coronary syndrome to an invasive or conservative strategy with a follow-up for 2 years. GDF-15 and other biomarkers were determined on admission in 2079 patients. GDF-15 was moderately elevated (between 1200 and 1800 ng/L) in 770 patients (37.0%), and highly elevated (>1800 ng/L) in 493 patients (23.7%). Elevated levels of GDF-15 independently predicted the risk of the composite end point of death or recurrent myocardial infarction in the conservative group (P=0.016) but not in the invasive group. A significant interaction existed between the GDF-15 level on admission and the effect of treatment strategy on the composite end point. The occurrence of the composite end point was reduced by the invasive strategy at GDF-15 levels >1800 ng/L (hazard ratio, 0.49; 95% confidence interval, 0.33 to 0.73; P=0.001), between 1200 and 1800 ng/L (hazard ratio, 0.68; 95% confidence interval, 0.46 to 1.00; P=0.048), but not <1200 ng/L (hazard ratio, 1.06; 95% confidence interval, 0.68 to 1.65; P=0.81). Patients with ST-segment depression or a troponin T level >0.01 microg/L with a GDF-15 level <1200 ng/L did not benefit from the invasive strategy.
Conclusions:
GDF-15 is a potential tool for risk stratification and therapeutic decision making in patients with non-ST-elevation acute coronary syndrome as initially diagnosed by ECG and troponin levels. A prospective randomized trial is needed to validate these findings.
