Growth-differentiation factor 15 for long-term prognostication in patients with non-ST-elevation acute coronary syndrome: An Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy

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• 作者：Peter Damman^a ; ¹ ; Tibor Kempf^b ; ¹ ; Fons Windhausen^a ; Jan P. van Straalen^c ; Anja Guba-Quint^b ; Johan Fischer^c ; Jan G.P. Tijssen^a ; Kai C. Wollert^b ; Robbert J. de Winter^a ; ^{r.j.dewinter@amc.uva.nl" class="auth_mail} ; Alexander Hirsch^a ; for the ICTUS investigators
• 关键词：CABG ; coronary artery bypass grafting ; CRP ; C-reactive protein ; GDF-15 ; growth differentiation factor 15 ; ICTUS ; Invasive versus Conservative Treatment in Unstable coronary Syndromes ; IDI ; integrated discrimination improvement ; MI ; myocardial infarction ; NRI ; net reclassification improvement ; NSTE-ACS ; non-ST-elevation acute coronary syndrome ; NT-proBNP ; N-terminal pro-brain natriuretic peptide ; PCI ; percutaneous coronary intervention
• 刊名：International Journal of Cardiology
• 出版年：15 March, 2014
• 年：2014
• 卷：172
• 期：2
• 页码：356-363
• 全文大小：413 K

文摘

Background

No five-year long-term follow-up data is available regarding the prognostic value of GDF-15. Our aim is to evaluate the long-term prognostic value of admission growth-differentiation factor 15 (GDF-15) regarding death or myocardial infarction (MI) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).

Methods

This is a subanalysis from the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial, including troponin positive NSTE-ACS patients. The main outcome for the current analysis was 5-year death or spontaneous MI. GDF-15 samples were available in 1151 patients. The prognostic value of GDF-15, categorized into < 1200 ng/L, 1200-1800 ng/L and > 1800 ng/L, was assessed in unadjusted and adjusted Cox regression models. Adjustments were made for identified univariable risk factors. The additional discriminative and reclassification value of GDF-15 beyond the independent risk factors was assessed by the category-free net reclassification improvement (1/2 NRI(> 0)) and the integrated discrimination improvement (IDI)

Results

Compared to GDF-15 < 1200 ng/L, a GDF-15 > 1800 ng/L was associated with an increased hazard ratio for death or spontaneous MI, mainly driven by mortality. GDF-15 levels were predictive after adjustments for other identified predictors. Additional discriminative value was shown with the IDI, not with the NRI.

Conclusion

In patients presenting with NSTE-ACS and elevated troponin T, GDF-15 provides prognostic information in addition to identified predictors for mortality and spontaneous MI and can be used to identify patients at high risk during long-term follow-up.