Growth-differentiation factor 15 for long-term prognostication in patients with non-ST-elevation acute coronary
Peter Damman1, Tibor Kempf2, Fons Windhausen1
1Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
Insights
Growth-differentiation factor 15 (GDF-15) predicts long-term risk of death or myocardial infarction (MI) in non-ST-elevation acute coronary syndrome (NSTE-ACS) patients. Elevated GDF-15 identifies high-risk individuals for improved patient management.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Prognostics
Background:
- Long-term prognostic data for growth-differentiation factor 15 (GDF-15) in non-ST-elevation acute coronary syndrome (NSTE-ACS) is limited.
- Accurate risk stratification is crucial for managing patients with NSTE-ACS.
- Admission GDF-15 levels may offer prognostic insights.
Purpose of the Study:
- To evaluate the long-term prognostic value of admission GDF-15 for death or myocardial infarction (MI) in NSTE-ACS patients.
- To assess if GDF-15 improves risk prediction beyond established factors.
Main Methods:
- Subanalysis of the ICTUS trial involving 1151 troponin-positive NSTE-ACS patients.
- GDF-15 levels categorized (<1200, 1200-1800, >1800 ng/L) and analyzed using Cox regression models.
- Prognostic value assessed via unadjusted and adjusted models, including integrated discrimination improvement (IDI) and net reclassification improvement (NRI).
Main Results:
- Higher GDF-15 levels (>1800 ng/L) were associated with increased hazard ratios for death or spontaneous MI compared to lower levels (<1200 ng/L), primarily driven by mortality.
- GDF-15 remained a significant predictor after adjusting for other risk factors.
- GDF-15 demonstrated additional discriminative value via IDI, but not NRI.
Conclusions:
- Admission GDF-15 provides significant prognostic information in NSTE-ACS patients with elevated troponin T.
- GDF-15 aids in identifying high-risk individuals for long-term follow-up.
- GDF-15 enhances risk prediction for mortality and spontaneous MI beyond existing predictors.
Background:
No five-year long-term follow-up data is available regarding the prognostic value of GDF-15. Our aim is to evaluate the long-term prognostic value of admission growth-differentiation factor 15 (GDF-15) regarding death or myocardial infarction (MI) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).
Methods:
This is a subanalysis from the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial, including troponin positive NSTE-ACS patients. The main outcome for the current analysis was 5-year death or spontaneous MI. GDF-15 samples were available in 1151 patients. The prognostic value of GDF-15, categorized into <1200 ng/L, 1200-1800 ng/L and >1800 ng/L, was assessed in unadjusted and adjusted Cox regression models. Adjustments were made for identified univariable risk factors. The additional discriminative and reclassification value of GDF-15 beyond the independent risk factors was assessed by the category-free net reclassification improvement (1/2 NRI(>0)) and the integrated discrimination improvement (IDI) RESULTS: Compared to GDF-15<1200 ng/L, a GDF-15>1800 ng/L was associated with an increased hazard ratio for death or spontaneous MI, mainly driven by mortality. GDF-15 levels were predictive after adjustments for other identified predictors. Additional discriminative value was shown with the IDI, not with the NRI.
Conclusion:
In patients presenting with NSTE-ACS and elevated troponin T, GDF-15 provides prognostic information in addition to identified predictors for mortality and spontaneous MI and can be used to identify patients at high risk during long-term follow-up.
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