July 29, 2008Open Access

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

Q: What is the clinical evidence from this study?

Study design: Observational. Population: acute chest pain (n=479). Intervention: Growth-differentiation factor-15 (GDF-15) vs. Normal GDF-15 levels (<1200 ng/L). Primary outcome: composite endpoint of death or (recurrent) MI (p=<0.001).

Key Result

Addition of GDF-15 to ECG and peak cTnI improved the prediction of 6-month death or recurrent MI in patients with acute chest pain (c-statistic 0.83 vs 0.74; P<0.001).

Study Design

Type

Observational (n=479)

PICO

Population

acute chest pain (n=479)

Intervention / Comparator

Growth-differentiation factor-15 (GDF-15) vs Normal GDF-15 levels (<1200 ng/L)

Primary Outcome

composite endpoint of death or (recurrent) MI, p=<0.001

Main Result

Absolute Event Rate: 12.6% vs 1.3%

p-value: p=<0.001

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 (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.