Key result
GDF-15 predicted all-cause mortality more accurately than hs-cTnT (AUC 0.85 vs 0.77; P=0.002) and BNP (AUC 0.75; P=0.007) in patients with acute chest pain, but was less accurate for diagnosing AMI.
Why the study?
Does GDF-15 measurement improve early diagnosis of AMI and risk stratification for all-cause mortality compared to hs-cTnT and BNP in patients with acute chest pain?
Observational (n=646)
Yes
Does GDF-15 measurement improve early diagnosis of AMI and risk stratification for all-cause mortality compared to hs-cTnT and BNP in patients with acute chest pain?
Effect estimate: AUC 0.85 (95% CI 0.81-0.90)
p-value: p=0.002
GDF-15 is a strong independent predictor of all-cause mortality in patients with acute chest pain, outperforming hs-cTnT and BNP, but it is not useful for the early diagnosis of AMI.
May support mortality risk stratification in acute chest pain; leaves open incremental value over hs-cTnT and BNP in prospective validation.
BACKGROUND: Growth differentiation factor-15 (GDF-15) is a stress-responsive marker that might aid in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction (AMI). METHODS: In a prospective, international multicenter study, GDF-15, high-sensitivity cardiac troponin T (hs-cTnT), and B-type natriuretic peptide (BNP) were measured in 646 unselected patients presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. The primary prognostic end point was all-cause mortality during a median follow-up of 26 months. RESULTS: AMI was the adjudicated final diagnosis in 115 patients (18%). GDF-15 concentrations at presentation were significantly higher in AMI patients compared to patients with other diagnoses. The diagnostic accuracy of GDF-15 at presentation for the diagnosis of AMI as quantified by the area under the ROC curve (AUC) was lower (AUC 0.69, 95% CI 0.64-0.74) compared to hs-cTnT (AUC 0.96, 95% CI 0.94-0.98, P < 0.001) and BNP (AUC 0.74, 95% CI 0.69-0.80, P = 0.02). A total of 55 deaths occurred during follow-up. GDF-15 predicted all-cause mortality independently of and more accurately than hs-cTnT [AUC 0.85 (95% CI 0.81-0.90) vs 0.77 (95% CI 0.72-0.83), P = 0.002] and BNP (AUC 0.75, 95% CI 0.68-0.82, P = 0.007). Net reclassification improvement was 0.15 (P = 0.01), and the absolute integrated discrimination improvement was 0.07, yielding a relative integrated discrimination improvement of 0.36 (P = 0.07). CONCLUSIONS: GDF-15 predicts all-cause mortality in unselected patients with acute chest pain independently of and more accurately than hs-cTnT and BNP. However, GDF-15 does not seem to help in the early diagnosis of AMI.
No takes yet. Share an insight, caveat, or question.
Schaub et al. (2011) conducted an observational in acute chest pain (n=646). Growth differentiation factor-15 (GDF-15) vs. hs-cTnT and BNP was evaluated on all-cause mortality (AUC 0.85, 95% CI 0.81-0.90, p=0.002). GDF-15 predicted all-cause mortality more accurately than hs-cTnT (AUC 0.85 vs 0.77; P=0.002) and BNP (AUC 0.75; P=0.007) in patients with acute chest pain, but was less accurate for diagnosing AMI.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: