GDF-15 predicts cardiovascular events in acute chest pain patients
Stergios Tzikas1,2, Lars Palapies3, Constantinos Bakogiannis1
13rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
Growth Differentiation Factor 15 (GDF-15) is a key biomarker for predicting cardiovascular events in patients with suspected acute myocardial infarction (AMI). Higher GDF-15 levels indicate increased risk and aid in identifying patients needing coronary revascularization.
Area of Science:
- Cardiology
- Biomarkers
- Acute Myocardial Infarction
Background:
- Timely diagnosis and risk stratification are crucial for managing patients with suspected acute myocardial infarction (AMI).
- Biomarkers play a vital role in aiding diagnosis and assessing patient risk.
- The predictive value of Growth Differentiation Factor 15 (GDF-15) in suspected AMI cases requires further evaluation.
Purpose of the Study:
- To evaluate the predictive capability of GDF-15 in patients presenting with symptoms suggestive of AMI.
- To determine if GDF-15 levels correlate with the severity of coronary artery disease (CAD).
- To assess GDF-15's utility in identifying and risk-stratifying patients who may require coronary revascularization.
Main Methods:
- A cohort of 1818 consecutive patients with suspected AMI was enrolled across three study centers.
- Cardiovascular events, defined as death or myocardial infarction (MI), were tracked over a 6-month follow-up period.
- GDF-15 levels were measured on admission and analyzed in relation to MI occurrence, adverse outcomes, and coronary artery disease severity (SYNTAX score).
Main Results:
- Patients with MI and those experiencing adverse outcomes exhibited significantly higher GDF-15 levels compared to their counterparts.
- Elevated GDF-15 levels on admission were associated with a 2.1-fold increased hazard ratio for death or MI, independent of age and sex.
- GDF-15 demonstrated significant reclassification ability for risk prediction when added to the GRACE score, with an NRI of 12.5% and IDI of 14.56%.
Conclusions:
- GDF-15 serves as an independent predictor of cardiovascular events in patients with suspected MI.
- GDF-15 levels correlate with the severity of coronary artery disease.
- GDF-15 can effectively identify and risk-stratify patients who would benefit from coronary revascularization.
Background:
Treatment of patients presenting with possible acute myocardial infarction (AMI) is based on timely diagnosis and proper risk stratification aided by biomarkers. We aimed at evaluating the predictive value of GDF-15 in patients presenting with symptoms suggestive of AMI.
Methods:
Consecutive patients presenting with suspected AMI were enrolled in three study centers. Cardiovascular events were assessed during a follow-up period of 6 months with a combined endpoint of death or MI.
Results:
From the 1818 enrolled patients (m/f = 1208/610), 413 (22.7%) had an acute MI and 63 patients reached the combined endpoint. Patients with MI and patients with adverse outcome had higher GDF-15 levels compared with non-MI patients (967.1pg/mL vs. 692.2 pg/L, p<0.001) and with event-free patients (1660 pg/mL vs. 756.6 pg/L, p<0.001). GDF-15 levels were lower in patients with SYNTAX score ≤ 22 (797.3 pg/mL vs. 947.2 pg/L, p = 0.036). Increased GDF-15 levels on admission were associated with a hazard ratio of 2.1 for death or MI (95%CI: 1.67-2.65, p<0.001) in a model adjusted for age and sex and of 1.57 (1.13-2.19, p = 0.008) adjusted for the GRACE score variables. GDF-15 showed a relevant reclassification with regards to the GRACE score with an overall net reclassification index (NRI) of 12.5% and an integrated discrimination improvement (IDI) of 14.56% (p = 0.006).
Conclusion:
GDF-15 is an independent predictor of future cardiovascular events in patients presenting with suspected MI. GDF-15 levels correlate with the severity of CAD and can identify and risk-stratify patients who need coronary revascularization.
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