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Growth Differentiation Factor-15 Levels at Admission Provide Incremental Prognostic Information on All-Cause
Mathijs C Bodde1, Maaike P J Hermans1, Arnoud van der Laarse1,2
1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Insights
Growth Differentiation Factor 15 (GDF-15) levels predict 10-year mortality in ST-elevation myocardial infarction (STEMI) patients. Measuring GDF-15 improves risk assessment beyond existing biomarkers and clinical factors.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- ST-segment elevation myocardial infarction (STEMI) poses significant mortality risks.
- Accurate prognostic markers are crucial for risk stratification in STEMI patients.
- Growth Differentiation Factor 15 (GDF-15) is a potential biomarker for cardiovascular outcomes.
Purpose of the Study:
- To evaluate the additive prognostic value of GDF-15 levels in STEMI patients treated with primary percutaneous coronary intervention (pPCI).
- To assess the impact of GDF-15 on 10-year all-cause mortality.
- To determine if GDF-15 improves risk stratification beyond clinical factors and NT-proBNP.
Main Methods:
- Serum GDF-15 levels were measured at baseline in 290 STEMI patients from the MISSION! trial.
- Patients were treated with pPCI between February 2004 and October 2006.
- 10-year all-cause mortality was the primary outcome, analyzed using Cox regression, Chi-square models, and C-index, adjusting for clinical variables and NT-proBNP.
Main Results:
- Higher GDF-15 and NT-proBNP levels were independently associated with increased 10-year all-cause mortality (HR GDF-15: 2.453, P=0.04; HR NT-proBNP: 2.413, P=0.04).
- Kaplan-Meier survival analysis showed significantly better survival for patients with GDF-15 and NT-proBNP below median levels.
- Adding GDF-15 to a model with clinical variables and NT-proBNP significantly improved risk prediction (C-statistic increased from 0.82 to 0.84, P=0.03).
Conclusions:
- GDF-15 levels at admission are an independent predictor of 10-year mortality in STEMI patients.
- GDF-15 provides incremental prognostic value for risk stratification in STEMI.
- GDF-15 can enhance risk assessment when used alongside clinical variables and other cardiac biomarkers like NT-proBNP.
Introduction:
To investigate the additive prognostic value of growth differentiation factor (GDF-15) levels in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneously coronary intervention (pPCI) with 10-year mortality on top of clinical characteristics and known cardiac biomarkers.
Methods:
Baseline serum GDF-15 levels were measured in 290 STEMI patients treated with pPCI in the MISSION! intervention trial conducted from February 1, 2004 through October 31, 2006. The incremental prognostic value of GDF-15 and NTproBNP levels was evaluated on top of clinical characteristics using Cox proportional hazards analysis, Chi-square models and C-index. Outcome was 10-year all-cause mortality.
Results:
Mean age was 59.0 ± 11.5 years and 65 (22.4) patients were female. A total of 37 patients died during a follow-up of 9.4 (IQR 8.8-10.0) years. Multivariable Cox regression revealed GDF-15 and NTproBNP levels above median to be independently associated with 10-year all-cause mortality [HR GDF-15, 2.453 (95% CI 1.064-5.658), P = 0.04; HR NTproBNP, 2.413 (95% CI 1.043-5.564), P = 0.04] after correction for other clinical variables. Stratified by median GDF-15 (37.78 pmol/L) and NTproBNP (11.74 pmol/L) levels, Kaplan-Meier curves showed significant better survival for patients with GDF-15 and NTproBNP levels below the median versus above the median. The likelihood ratio test showed a significant incremental value of GDF-15 (P = 0.03) as compared with a model with clinically important variables and NTproBNP. The C-statistics for this model improved from 0.82 to 0.84 when adding GDF-15.
Conclusion:
GDF-15 levels at admission in STEMI patients are independently associated with 10-year all-cause mortality rates and could improve risk stratification on top of clinical variables and other cardiac biomarkers.
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