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October 2, 2025Open Access

Growth Differentiation Factor‐15 is Associated With Acute Myocardial Infarction and Death at 30 and 90 Days in Emergency Department Patients With Suspected Acute Coronary Syndrome

BMBryn E. MummaUniversity of California, Davis NBNipun BhandariUniversity of California, Davis NTNam K. TranUniversity of Pittsburgh

Key Points

GDF-15 was independently associated with all-cause death or AMI at 30 days and 90 days.
Outcomes included 12% experiencing the composite event at index visit and additional occurrences later.
Analysis involved 1428 patients from multiple emergency departments in the US during 2017-2018.
The findings highlight the potential role of GDF-15 in cardiac risk assessment for emergency patients.

Abstract

Background Growth differentiation factor‐15 (GDF‐15) is a novel biomarker of cardiac stress. GDF‐15 may be a stronger predictor of all‐cause death in patients with acute chest pain than traditional biomarkers such as high‐sensitivity troponin T and BNP (B‐type natriuretic peptide). However, data from US populations are lacking. Our objective was to determine whether GDF‐15 is an independent predictor of all‐cause death or acute myocardial infarction (AMI) at index visit, 30 days, and 90 days. Methods We conducted a secondary analysis of the STOP‐CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) trial, which prospectively enrolled adults (aged ≥21 years) from 8 US emergency departments with suspected AMI in 2017 to 2018. High‐sensitivity troponin T, BNP, and GDF‐15 assays were performed at a central laboratory on samples from baseline and 3 hours later. The primary outcome was the composite of all‐cause death or AMI at index visit, 30 days, and 90 days. Multiple logistic regression models assessed the association between GDF‐15 and all‐cause death or AMI at index visit, as well as at 30 and 90 days, while adjusting for age, sex, number of cardiac risk factors, ischemic ECG findings, high‐sensitivity troponin T, and N‐terminal pro‐B‐type natriuretic peptide. Results We studied 1428 patients; median age was 58 (interquartile range, 49–66) years and 353 (25%) had a history of coronary artery disease. The composite outcome of all‐cause death or AMI occurred in 169 (12%) patients at index visit, an additional 21 (1.5%) at 30 days, and an additional 27 (1.9%) at 90 days. In multiple logistic regression models, GDF‐15 was independently associated with all‐cause death or AMI at 30 days (adjusted odds ratio per SD, 1.27 95% CI, 1.06–1.54) and 90 days (adjusted odds ratio R per SD, 1.55 95% CI, 1.26–1.94), but not during the index visit (adjusted odds ratio per SD, 1.00 95% CI, 0.83–1.16). Conclusions Among adult emergency department patients with suspected AMI, GDF‐15 was independently associated with subsequent 30‐day and 90‐day all‐cause death or AMI. These data suggest a potential role for GDF‐15 in short‐term cardiac risk stratification in emergency department patients without AMI at index visit.

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