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Growth Differentiation Factor 15 for Risk Stratification and Selection of an Invasive Treatment Strategy in Non-ST-Elevation Acute Coronary Syndrome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. (UCR)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. (UCR)
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2007 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 116, no 14, 1540-1548 p.Article in journal (Refereed) Published
Abstract [en]

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.
Keyword [en]
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
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Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-13868DOI: 10.1161/CIRCULATIONAHA.107.697714ISI: 000250013200004PubMedID: 17848615OAI: oai:DiVA.org:uu-13868DiVA: diva2:41638
Available from: 2008-06-03 Created: 2008-06-03 Last updated: 2017-12-11Bibliographically approved

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Lagerqvist, BoLindahl, BertilOlofsson, SylviaSiegbahn, AgnetaVenge, PerWallentin, Lars

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