January 30, 2019Cardiology and TherapyOpen Access

Growth Differentiation Factor-15 Levels at Admission Provide Incremental Prognostic Information on All-Cause Long-term Mortality in ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention

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Why the study?

The study investigated the additive prognostic value of GDF-15 levels for 10-year mortality on top of clinical characteristics and known cardiac biomarkers in STEMI patients treated with pPCI.

Do baseline GDF-15 levels predict 10-year all-cause mortality in STEMI patients treated with pPCI?

Structured PICO

Do baseline GDF-15 levels predict 10-year all-cause mortality in STEMI patients treated with pPCI?

Population

290 STEMI patients treated with primary percutaneous coronary intervention (pPCI) in the MISSION! intervention trial, mean age 59.0 ± 11.5 years, 22.4% female.

Intervention

Baseline serum GDF-15 levels (above median)

Comparator

Baseline serum GDF-15 levels (below median)

Outcome

10-year all-cause mortalityhard clinical

GDF-15 levels at admission provide incremental prognostic value for 10-year all-cause mortality in STEMI patients treated with pPCI, beyond clinical variables and NT-proBNP.

Implication

May support long-term risk stratification post-STEMI pPCI; hypothesis-generating and requires prospective validation before clinical use.

Abstract

To investigate the additive prognostic value of growth differentiation factor (GDF-15) levels in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneously coronary intervention (pPCI) with 10-year mortality on top of clinical characteristics and known cardiac biomarkers. Baseline serum GDF-15 levels were measured in 290 STEMI patients treated with pPCI in the MISSION! intervention trial conducted from February 1, 2004 through October 31, 2006. The incremental prognostic value of GDF-15 and NTproBNP levels was evaluated on top of clinical characteristics using Cox proportional hazards analysis, Chi-square models and C-index. Outcome was 10-year all-cause mortality. Mean age was 59.0 ± 11.5 years and 65 (22.4) patients were female. A total of 37 patients died during a follow-up of 9.4 (IQR 8.8–10.0) years. Multivariable Cox regression revealed GDF-15 and NTproBNP levels above median to be independently associated with 10-year all-cause mortality [HR GDF-15, 2.453 (95% CI 1.064–5.658), P = 0.04; HR NTproBNP, 2.413 (95% CI 1.043–5.564), P = 0.04] after correction for other clinical variables. Stratified by median GDF-15 (37.78 pmol/L) and NTproBNP (11.74 pmol/L) levels, Kaplan–Meier curves showed significant better survival for patients with GDF-15 and NTproBNP levels below the median versus above the median. The likelihood ratio test showed a significant incremental value of GDF-15 (P = 0.03) as compared with a model with clinically important variables and NTproBNP. The C-statistics for this model improved from 0.82 to 0.84 when adding GDF-15. GDF-15 levels at admission in STEMI patients are independently associated with 10-year all-cause mortality rates and could improve risk stratification on top of clinical variables and other cardiac biomarkers.