Growth differentiation factor-15 and all-cause mortality in patients with suspected myocardial infarction
Joan Walter1, Thomas Nestelberger2, Jasper Boeddinghaus1
1Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland; GREAT network, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
Insights
Growth Differentiation Factor-15 (GDF-15) effectively predicts 2-year mortality in suspected acute myocardial infarction (AMI) patients. Elevated GDF-15 levels identify high-risk individuals, while specific cutoffs identify low-risk patients with high accuracy.
Area of Science:
- Cardiology
- Biomarkers
- Prognostic Medicine
Background:
- Assessing prognostic performance of Growth Differentiation Factor-15 (GDF-15) in patients with suspected acute myocardial infarction (AMI).
- Utilizing high-sensitivity cardiac troponin (hs-cTn) for adjudication of AMI diagnosis.
Purpose of the Study:
- To evaluate the prognostic accuracy of GDF-15 concentrations for predicting mortality in unselected patients presenting with suspected AMI.
- To compare the prognostic performance of GDF-15 with hs-cTnT in this patient cohort.
Main Methods:
- Prospective, multicenter diagnostic study including 718 patients with suspected AMI.
- Central adjudication of AMI diagnosis by independent cardiologists using comprehensive clinical data.
- Measurement of GDF-15 and hs-cTnT concentrations at emergency department presentation.
Main Results:
- GDF-15 demonstrated superior prognostic performance for 2-year all-cause death compared to hs-cTnT in AMI patients (AUC 0.89 vs 0.55).
- A GDF-15 cutoff of ≤1560 ng/L identified 47% of AMI patients with 100% sensitivity for 2-year mortality.
- In non-AMI patients, GDF-15 also showed strong predictive accuracy (AUC 0.83) for 2-year death.
Conclusions:
- GDF-15 concentrations at presentation are highly predictive of all-cause mortality in suspected AMI patients.
- GDF-15 facilitates identification of a significant proportion of AMI patients at very low risk of 2-year mortality.
- GDF-15 offers valuable prognostic information beyond hs-cTnT in the emergency department setting.
Background:
To assess the prognostic performance of Growth differentiation factor-15 (GDF-15) concentrations in unselected patients presenting with suspected acute myocardial infarction (AMI) and adjudication based on high-sensitivity cardiac troponin (hs-cTn).
Methods And Results:
In an ongoing prospective multicenter diagnostic study, consecutive patients presenting with suspected AMI to the emergency department and available GDF-15 and hs-cTnT concentrations were included. Adjudication of AMI was performed central by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations. Overall, 718 patients were included, with 23% (162/718) having an adjudicated diagnosis of AMI. The cumulative incidence of death within 2 years was 19% in patients with AMI (30 deaths in 162 patients) versus 5% in patients without AMI (25 deaths in 556 patients; P < 0.001). In AMI patients, GDF-15 provided an AUC of 0.89 (95% confidence interval [CI] 0.83-0.94) for 2-year death versus 0.55 (95% CI 0.44-0.66) for hs-cTnT (P < 0.001). A GDF-15 cutoff of ≤1560 ng/L predicted 2-year survival in 47% (76/162) of AMI patients and had 100% sensitivity (95% CI 88-100%) for 2-year death. In patients without AMI, GDF-15 provided an AUC of 0.83 (95% CI 0.76-0.89) versus 0.76 (95% CI 0.67-0.85) for hs-cTnT (P = 0.096). A GDF-15 cutoff of ≤886 ng/L predicted 2-year survival in 37% (203/556) of non-AMI patients and had 100% sensitivity (95% CI 86-100%) for 2-year death.
Conclusions:
GDF-15 concentrations at emergency department presentation have a high predictive accuracy for all-cause death in patients with suspected AMI and allow the identification of a large proportion of AMI patients with very low mortality risk.
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