Growth Differentiation Factor 15 for Risk Stratification and Selection of an Invasive Treatment Strategy in Non-ST-Elevation Acute Coronary Syndrome
2007 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 116, no 14, 1540-1548 p.Article in journal (Refereed) Published
Background— An invasive treatment strategy improves outcomein patients with non–ST-elevation acute coronary syndromeat moderate to high risk. We hypothesized that the circulatinglevel of growth differentiation factor 15 (GDF-15) may improverisk stratification.
Methods and Results— The Fast Revascularization duringInStability in Coronary artery disease II (FRISC-II) trial randomizedpatients with non–ST-elevation acute coronary syndrometo an invasive or conservative strategy with a follow-up for2 years. GDF-15 and other biomarkers were determined on admissionin 2079 patients. GDF-15 was moderately elevated (between 1200and 1800 ng/L) in 770 patients (37.0%), and highly elevated(>1800 ng/L) in 493 patients (23.7%). Elevated levels ofGDF-15 independently predicted the risk of the composite endpoint of death or recurrent myocardial infarction in the conservativegroup (P=0.016) but not in the invasive group. A significantinteraction existed between the GDF-15 level on admission andthe effect of treatment strategy on the composite end point.The occurrence of the composite end point was reduced by theinvasive strategy at GDF-15 levels >1800 ng/L (hazard ratio,0.49; 95% confidence interval, 0.33 to 0.73; P=0.001), between1200 and 1800 ng/L (hazard ratio, 0.68; 95% confidence interval,0.46 to 1.00; P=0.048), but not <1200 ng/L (hazard ratio,1.06; 95% confidence interval, 0.68 to 1.65; P=0.81). Patientswith ST-segment depression or a troponin T level >0.01 µg/Lwith a GDF-15 level <1200 ng/L did not benefit from the invasivestrategy.
Conclusions— GDF-15 is a potential tool for risk stratificationand therapeutic decision making in patients with non–ST-elevationacute coronary syndrome as initially diagnosed by ECG and troponinlevels. A prospective randomized trial is needed to validatethese findings.
Place, publisher, year, edition, pages
2007. Vol. 116, no 14, 1540-1548 p.
Acute Disease, Aged, Biological Markers/*blood, Coronary Artery Disease/*blood/diagnosis/epidemiology/*therapy, Cytokines/*blood, Electrocardiography, Female, Humans, Male, Middle Aged, Myocardial Revascularization, Risk Factors, Treatment Outcome, Troponin T/blood
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-13868DOI: 10.1161/CIRCULATIONAHA.107.697714ISI: 000250013200004PubMedID: 17848615OAI: oai:DiVA.org:uu-13868DiVA: diva2:41638