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Growth Differentiation Factor-15 is Associated With Acute Myocardial Infarction and Death at 30 and 90 Days in
Bryn E Mumma1, Nipun Bhandari2, Nam K Tran3
1Department of Emergency Medicine, School of Medicine University of California Davis Sacramento CA USA.
Insights
Growth Differentiation Factor-15 (GDF-15) independently predicts 30-day and 90-day mortality in emergency department patients with suspected acute myocardial infarction (AMI). GDF-15 may aid in short-term cardiac risk stratification.
Area of Science:
- Cardiology
- Biomarker Research
- Emergency Medicine
Background:
- Growth Differentiation Factor-15 (GDF-15) is a novel biomarker for cardiac stress.
- GDF-15 may outperform traditional biomarkers like troponin T and BNP in predicting mortality for acute chest pain patients.
- Limited data exists on GDF-15's predictive value in US populations.
Purpose of the Study:
- To evaluate GDF-15 as an independent predictor of all-cause death or acute myocardial infarction (AMI).
- To assess GDF-15's predictive accuracy at the index visit, 30 days, and 90 days.
- To investigate GDF-15's role in US emergency department patients with suspected AMI.
Main Methods:
- Secondary analysis of the STOP-CP trial involving 1428 adult emergency department patients.
- GDF-15, high-sensitivity troponin T, and BNP levels were measured at baseline and 3 hours.
- Multiple logistic regression models adjusted for clinical factors to assess GDF-15's association with composite outcomes.
Main Results:
- The composite outcome of all-cause death or AMI occurred in 12% at index visit, 1.5% at 30 days, and 1.9% at 90 days.
- GDF-15 was independently associated with all-cause death or AMI at 30 days (aOR 1.27) and 90 days (aOR 1.55).
- No significant association was found between GDF-15 and outcomes at the index visit.
Conclusions:
- GDF-15 is an independent predictor of 30-day and 90-day all-cause death or AMI in emergency department patients with suspected AMI.
- GDF-15 shows potential for short-term cardiac risk stratification in this patient group.
- Further research can explore GDF-15's integration into clinical decision-making tools.
Background:
Growth differentiation factor-15 (GDF-15) is a novel biomarker of cardiac stress. GDF-15 may be a stronger predictor of all-cause death in patients with acute chest pain than traditional biomarkers such as high-sensitivity troponin T and BNP (B-type natriuretic peptide). However, data from US populations are lacking. Our objective was to determine whether GDF-15 is an independent predictor of all-cause death or acute myocardial infarction (AMI) at index visit, 30 days, and 90 days.
Methods:
We conducted a secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) trial, which prospectively enrolled adults (aged ≥21 years) from 8 US emergency departments with suspected AMI in 2017 to 2018. High-sensitivity troponin T, BNP, and GDF-15 assays were performed at a central laboratory on samples from baseline and 3 hours later. The primary outcome was the composite of all-cause death or AMI at index visit, 30 days, and 90 days. Multiple logistic regression models assessed the association between GDF-15 and all-cause death or AMI at index visit, as well as at 30 and 90 days, while adjusting for age, sex, number of cardiac risk factors, ischemic ECG findings, high-sensitivity troponin T, and N-terminal pro-B-type natriuretic peptide.
Results:
We studied 1428 patients; median age was 58 (interquartile range, 49-66) years and 353 (25%) had a history of coronary artery disease. The composite outcome of all-cause death or AMI occurred in 169 (12%) patients at index visit, an additional 21 (1.5%) at 30 days, and an additional 27 (1.9%) at 90 days. In multiple logistic regression models, GDF-15 was independently associated with all-cause death or AMI at 30 days (adjusted odds ratio per SD, 1.27 [95% CI, 1.06-1.54]) and 90 days (adjusted odds ratio R per SD, 1.55 [95% CI, 1.26-1.94]), but not during the index visit (adjusted odds ratio per SD, 1.00 [95% CI, 0.83-1.16]).
Conclusions:
Among adult emergency department patients with suspected AMI, GDF-15 was independently associated with subsequent 30-day and 90-day all-cause death or AMI. These data suggest a potential role for GDF-15 in short-term cardiac risk stratification in emergency department patients without AMI at index visit.
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