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.
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?
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.
Effect estimate: AUC 0.85 (95% CI 0.81-0.90)
p-value: p=0.002
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.
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.