Limited incremental value of growth differentiation factor 15 in the initial evaluation of low and intermediate risk
Iman Karaji1, Ole-Thomas Steiro2, Gard Ms Myrmel1
1Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Faculty of Medicine, University of Bergen, Norway.
Insights
Growth Differentiation Factor 15 (GDF-15) did not significantly predict obstructive coronary artery disease (CAD) or revascularization needs in low-risk acute chest pain patients. These findings question the clinical utility of GDF-15 for prognostication in this population.
Area of Science:
- Cardiology
- Biomarkers
- Diagnostic Imaging
Background:
- Growth Differentiation Factor 15 (GDF-15) is elevated during tissue injury and stress.
- Its predictive value for obstructive coronary artery disease (CAD) and revascularization in acute chest pain patients is unclear.
Purpose of the Study:
- To evaluate if GDF-15 predicts obstructive CAD or the need for revascularization within 30 days and 12 months.
- To assess GDF-15's prognostic utility in low/intermediate risk patients presenting with acute chest pain.
Main Methods:
- 537 hospitalized patients with high-sensitivity troponin T (hs-cTnT) below the 99th percentile underwent coronary CT angiography (CCTA).
- Logistic regression analyses were used to calculate odds ratios (ORs) for GDF-15 (log-transformed) predicting outcomes.
- Analyses were adjusted for age, sex, and clinical covariables.
Main Results:
- GDF-15 was initially associated with obstructive CAD and revascularization needs in age/sex-adjusted analyses.
- After adjustment for clinical covariables, GDF-15 lost its statistical significance as a predictor.
- Adding hs-cTnT levels to the model also rendered GDF-15 non-significant.
Conclusions:
- GDF-15 did not substantially improve the identification of obstructive CAD or revascularization needs in patients with acute chest pain but no acute myocardial infarction.
- The clinical usefulness of GDF-15 for prognostication in low-risk acute chest pain patients is questionable.
Introduction:
Expression of the cytokine growth differentiation factor 15 (GDF-15) is up-regulated in conditions of tissue injury and stress. We evaluated if GDF-15 predicts obstructive coronary artery disease (CAD) or need for revascularization within 30 days and 12 months in low/intermediate risk patients with acute chest pain.
Materials And Methods:
We included 537 hospitalized patients who had high-sensitivity troponin T (hs-cTnT) < 99th percentile and underwent coronary CT angiography (CCTA). Odds ratios (ORs) and 95 % confidence intervals (CI) were calculated by logistic regression analyses and are reported per standard deviation increment of GDF-15 (log-transformed).
Results:
The median (25th-75th percentile) age was 56 (49-65) years, 217 (40.4 %) were women, 83 (15.5 %) had obstructive CAD at CCTA. In total 49 (9.1 %) patients underwent revascularization within 30 days and 52 (9.7 %) within 12 months. In age and sex adjusted analysis GDF-15 was a significant predictor with ORs (95 % CI) of 1.35 (1.05-1.73), 1.39 (1.06-1.83) and 1.41 (1.07-1.84) for obstructive CAD, revascularization within 30 days and 12 months, respectively. However, after adjustment for clinical covariables, the ORs of GDF-15 were no longer statistically significant for either outcome (P ≥ 0.07). Adding hs-cTnT levels alone to the age and sex adjusted model also rendered the ORs of GDF-15 non-significant (P ≥ 0.31).
Conclusions:
In patients with acute chest pain but without acute myocardial infarction, GDF-15 did not substantially improve the identification of obstructive CAD or need for revascularization within 30 days and 12 months. Our findings question the clinical usefulness of GDF-15 for prognostication of low-risk patients with acute chest pain.
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