Journal
INTERNATIONAL JOURNAL OF CARDIOLOGY
Volume 172, Issue 2, Pages 356-363Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ijcard.2014.01.025
Keywords
Long-term outcomes; Non-ST-elevation acute coronary syndrome; Growth-differentiation factor 15
Categories
Funding
- Interuniversitary Cardiology Institute of the Netherlands (ICIN)
- Working group on Cardiovascular Research of the Netherlands (WCN)
- Eli Lilly
- Sanofi/Synthelabo
- Aventis
- Pfizer
- Medtronic
- German Ministry of Education and Research (BMBF, BioChancePlus)
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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. (C) 2014 Elsevier Ireland Ltd. All rights reserved.
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