Growth-differentiation factor-15 for long-term risk prediction in patients stabilized after an episode of
Kai M Eggers1, Tibor Kempf, Bo Lagerqvist
1Department of Medical Sciences, Cardiology, Uppsala University Hospital and Uppsala Clinical Research Center, Uppsala, Sweden. kai.eggers@ucr.uu.se
Insights
Growth-differentiation factor-15 (GDF-15) is a key prognostic biomarker for non-ST-segment-elevation acute coronary syndrome. Persistently elevated GDF-15 levels up to 6 months post-event indicate a higher risk of adverse cardiovascular outcomes.
Area of Science:
- Cardiology
- Biomarker Research
- Acute Coronary Syndromes
Background:
- Growth-differentiation factor-15 (GDF-15) is recognized as a prognostic indicator in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS).
- This study investigated the temporal changes and long-term prognostic value of repeated GDF-15 measurements in NSTE-ACS patients.
Purpose of the Study:
- To assess the dynamic changes in GDF-15 levels over 6 months post-NSTE-ACS.
- To determine the long-term prognostic relevance of these GDF-15 levels for major adverse cardiovascular events.
Main Methods:
- 950 NSTE-ACS patients from the FRISC II study had GDF-15 measured at randomization, 6 weeks, 3 months, and 6 months.
- Outcomes included death and recurrent myocardial infarction over a 5-year follow-up period.
Main Results:
- Median GDF-15 levels showed a slight decrease from 1357 ng/L to 1302 ng/L at 6 months (P<0.001).
- GDF-15 levels correlated with cardiovascular risk factors, hemodynamic stress, renal dysfunction, and inflammation.
- Elevated GDF-15 at 3 and 6 months independently predicted a 5-year risk of composite endpoints (aHR 1.8 and 2.3, respectively).
- Persistently high GDF-15 (>1800 ng/L) identified patients with the highest risk.
Conclusions:
- GDF-15 is an independent predictor of adverse events in NSTE-ACS, both acutely and up to 6 months post-stabilization.
- Serial GDF-15 measurements can stratify patient risk.
- Further research should explore GDF-15's role in managing acute and chronic ischemic heart disease.
Background:
Growth-differentiation factor-15 (GDF-15) has emerged as a prognostic biomarker in patients with non-ST-segment-elevation acute coronary syndrome. This study assessed the time course and the long-term prognostic relevance of GDF-15 levels measured repetitively in patients with non-ST-segment-elevation acute coronary syndrome during 6 months after the acute event.
Methods And Results:
GDF-15 and other biomarkers were measured at randomization, after 6 weeks, and after 3 and 6 months in 950 patients with non-ST-segment-elevation acute coronary syndrome included in the FRagmin and Fast Revascularization during InStability in Coronary artery disease II study. Study end points were death, recurrent myocardial infarction, and their composite during 5-year follow-up. Median GDF-15 levels decreased slightly from 1357 ng/L at randomization to 1302 ng/L at 6 months (P<0.001). GDF-15 was consistently related to cardiovascular risk factors and biochemical markers of hemodynamic stress, renal dysfunction, and inflammation. Moreover, GDF-15 was independently related to the 5-year risk of the composite end point when measured at both 3 months (adjusted hazard ratio, 1.8 [1.0 to 3.0]) and 6 months (adjusted hazard ratio, 2.3 [1.3 to 4.1]). Serial measurements of GDF-15 at randomization and 6 months helped to identify patient cohorts at different levels of risk, with patients with persistently elevated GDF-15 levels >1800 ng/L having the highest rate of the composite end point.
Conclusions:
GDF-15 is independently related to adverse events in non-ST-segment-elevation acute coronary syndrome both in the acute setting and for at least 6 months after clinical stabilization. Therefore, continued research on GDF-15 should be focused on the usefulness of GDF-15 for support of clinical management in acute and chronic ischemic heart disease.
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