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Prognostic value of growth-differentiation factor-15 in patients with non-ST-elevation acute coronary syndrome
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
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2007 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 115, no 8, 962-971 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Growth-differentiation factor-15 (GDF-15) is a member of the transforming growth factor-beta cytokine superfamily that is induced in the heart after ischemia-and-reperfusion injury. Circulating levels of GDF-15 may provide prognostic information in patients with non-ST-elevation acute coronary syndrome. METHODS AND RESULTS: Blood samples were obtained on admission from 2081 patients with acute chest pain and either ST-segment depression or troponin elevation who were included in the Global Utilization of Strategies to Open Occluded Arteries (GUSTO)-IV Non-ST-Elevation Acute Coronary Syndrome trial and from a matching cohort of 429 apparently healthy individuals. GDF-15 levels were determined by immunoradiometric assay. Approximately two thirds of patients presented with GDF-15 levels above the upper limit of normal in healthy controls (1200 ng/L); one third presented with levels >1800 ng/L. Increasing tertiles of GDF-15 were associated with an enhanced risk of death at 1 year (1.5%, 5.0%, and 14.1%; P<0.001). By multiple Cox regression analysis, only the levels of GDF-15 and N-terminal pro-B-type natriuretic peptide, together with age and a history of previous myocardial infarction, contributed independently to 1-year mortality risk. Receiver operating characteristic curve analyses further illustrated that GDF-15 is a strong marker of 1-year mortality risk (area under the curve, 0.757; best cutoff, 1808 ng/L). At this cutoff value, GDF-15 added significant prognostic information in patient subgroups defined by age; gender; time from symptom onset to admission; cardiovascular risk factors; previous cardiovascular disease; and the risk markers ST-segment depression, troponin T, N-terminal pro-B-type natriuretic peptide, C-reactive protein, and creatinine clearance. CONCLUSIONS: GDF-15 is a new biomarker of the risk for death in patients with non-ST-elevation acute coronary syndrome that provides prognostic information beyond that provided by established clinical and biochemical markers.

Place, publisher, year, edition, pages
2007. Vol. 115, no 8, 962-971 p.
Keyword [en]
Acute coronary syndrome, Biomarkers, Growth-differentiation factor-15, Prognosis
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-17358DOI: 10.1161/CIRCULATIONAHA.106.650846ISI: 000244482200007PubMedID: 17283261OAI: oai:DiVA.org:uu-17358DiVA: diva2:45129
Available from: 2008-06-19 Created: 2008-06-19 Last updated: 2012-07-11Bibliographically approved

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Olofsson, SylviaJames, StefanJohnston, NinaLindahl, BertilWallentin, Lars
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