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Multicenter Study
. 2008 Oct;29(19):2327-35.
doi: 10.1093/eurheartj/ehn339. Epub 2008 Jul 29.

Growth-differentiation factor-15 for early risk stratification in patients with acute chest pain

Kai M Eggers  1 , Tibor Kempf, Tim Allhoff, Bertil Lindahl, Lars Wallentin, Kai C Wollert
Affiliations
Multicenter Study

Growth-differentiation factor-15 for early risk stratification in patients with acute chest pain

Kai M Eggers et al. Eur Heart J. 2008 Oct.

Abstract

Aims: Growth-differentiation factor-15 (GDF-15) has emerged as a biomarker of increased mortality and recurrent myocardial infarction (MI) in patients diagnosed with non-ST-elevation acute coronary syndrome. We explored the usefulness of GDF-15 for early risk stratification in 479 unselected patients with acute chest pain.

Methods and results: Sixty-nine per cent of the patients presented with GDF-15 levels above the previously defined upper reference limit (1200 ng/L). The risks of the composite endpoint of death or (recurrent) MI after 6 months were 1.3, 5.1, and 12.6% in patients with normal (<1200 ng/L), moderately elevated (1200-1800 ng/L), or markedly elevated (>1800 ng/L) levels of GDF-15 on admission, respectively (P < 0.001). By multivariable analysis that included clinical characteristics, ECG findings, peak cardiac troponin I levels within 2 h (cTnI(0-2 h)), N-terminal pro-B-type natriuretic peptide, C-reactive protein, and cystatin C, GDF-15 remained an independent predictor of the composite endpoint. The ability of the ECG combined with peak cTnI(0-2 h) to predict the composite endpoint was markedly improved by addition of GDF-15 (c-statistic, 0.74 vs. 0.83; P < 0.001).

Conclusion: GDF-15 improves risk stratification in unselected patients with acute chest pain and provides prognostic information beyond clinical characteristics, the ECG, and cTnI.

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Figures

Figure 1
Figure 1
Levels of growth-differentiation factor-15 on admission in relation to index diagnosis. For each diagnosis, the percentages of patients with growth-differentiation factor-15 levels <1200 ng/L, between 1200 and 1800 ng/L, and >1800 ng/L are shown. Absolute patient numbers are shown in each bar.
Figure 2
Figure 2
Outcome according to levels of growth-differentiation factor-15 on admission. (A) The risks of death, (recurrent) MI, and of the composite endpoint after 6 months are shown. The number of events is shown in each bar. (B) The Kaplan–Meier curve illustrating the timing of events for the composite endpoint in the three strata of growth-differentiation factor-15. (Re)-MI denotes (recurrent) myocardial infarction.
Figure 3
Figure 3
Outcome according to the ECG, peak cTnI levels within 2 h, and growth-differentiation factor-15. Patients were stratified according to the presence or absence of an abnormal ECG on admission or according to their peak cTnI0–2 h level (cTnI). Patients were then classified according to their levels of growth-differentiation factor-15 on admission using the pre-specified cut-offs, 1200 ng/L (A) and 1800 ng/L (B). The number of events per number of patients is shown in each bar.
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Comment in

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