Long-term prognostic value of growth differentiation factor-15 in acute coronary syndromes
Óscar M Peiró1, Álvaro García-Osuna2, Jordi Ordóñez-Llanos2
1Department of Cardiology, Joan XXIII University Hospital, Tarragona, Spain; Pere Virgili Health Research Institute, Rovira i Virgili University, Tarragona, Spain.
Insights
Growth Differentiation Factor-15 (GDF-15) levels above 1800 ng/L predict long-term death and major adverse cardiovascular events in acute coronary syndrome (ACS) patients. GDF-15 offers significant prognostic value beyond traditional risk factors.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- Growth Differentiation Factor-15 (GDF-15) is a known predictor of mortality and cardiovascular events in acute coronary syndromes (ACS).
- The long-term prognostic implications of GDF-15 in ACS require further investigation.
Purpose of the Study:
- To evaluate the long-term prognostic value of Growth Differentiation Factor-15 (GDF-15) in patients with acute coronary syndromes (ACS).
- To determine if GDF-15 provides incremental prognostic information beyond established clinical risk factors.
Main Methods:
- 358 patients with ACS undergoing coronary angiography were included.
- Plasma GDF-15 levels were measured, and clinical data and long-term outcomes were collected over 6.5 years.
- The incremental predictive value of GDF-15 for all-cause death was assessed using a clinical model including GRACE score, LVEF <40%, prior MI, and age.
Main Results:
- GDF-15 concentrations >1800 ng/L were linked to increased cardiovascular risk factors.
- Elevated GDF-15 (>1800 ng/L) independently predicted all-cause death (HR 4.09) and major adverse cardiovascular events (MACE) (HR 2.48) after adjustment.
- GDF-15 addition significantly improved risk prediction models for long-term all-cause death (ROC, NRI, IDI).
- High GDF-15 was associated with heart failure incidence but not myocardial infarction in competing risk analysis.
Conclusions:
- In ACS patients, GDF-15 is a significant predictor of long-term all-cause mortality, MACE, and heart failure.
- GDF-15 offers incremental prognostic value, enhancing risk stratification beyond traditional factors in ACS.
- Elevated GDF-15 levels (>1800 ng/L) identify high-risk individuals requiring closer monitoring.
Background:
Growth Differentiation Factor-15 (GDF-15) predicts death and cardiovascular events in acute coronary syndromes (ACS). We aimed to assess the long-term prognostic value of GDF-15 in ACS.
Methods:
We included 358 patients with ACS who underwent coronary angiography. Plasma GDF-15 was measured and clinical data and long-term events were registered. Incremental value of GDF-15 for prognosing all-cause death above a clinical model including GRACE score, left ventricular ejection fraction <40%, prior myocardial infarction and age was assessed.
Results:
GDF-15 concentrations >1800 ng/L were associated with an increased prevalence of cardiovascular risk factors. During 6.5 years of follow-up 56 patients died, 7 had values of GDF-15 < 1200 ng/L, 7 between 1200 and 1800 ng/L and 42 > 1800 ng/L. After adjustment for potential confounders, GDF-15 > 1800 ng/L were independently associated with all-cause death (HR 4.09; 95% CI 1.57-10.71; p = .004) and the composite of major adverse cardiovascular events (MACE) (HR 2.48; 95% CI 1.41-4.34; p = .001). For long-term all-cause death a significant increase of ROC curve was seen after addition of GDF-15 to a clinical model 0.876 (95% CI 0.823-0.928; p = .014). Same improvements were found for net reclassification improvement (0.776; 95% CI 0.494-1.037; p < .001) and integrated discrimination improvement (0.112; 95% CI 0.055-0.169; p < .001). Multivariate competing risk model showed a significant association between GDF-15 > 1800 ng/L and the incidence of heart failure but not of myocardial infarction.
Conclusions:
In the setting of ACS, GDF-15 is associated with long-term all-cause death, MACE and heart failure and provides incremental prognostic value beyond traditional risks factor.
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