Growth differentiation factor-15 and all-cause mortality in patients with suspected myocardial infarction

Authors	WALTER Joan NESTELBERGER Thomas BOEDDINGHAUS Jasper TWERENBOLD Raphael CROTON Lukas BADERTSCHER Patrick WILDI Karin WUSSLER Desiree DE LAVALLAZ Jeanne du Fay MUELLER Christian GIMENEZ Maria Rubini PUELACHER Christian KOZHUHAROV Nikola MORAWIEC Beata RENTSCH Katharina MIRO Oscar MARTIN-SANCHEZ F. Javier MUZYK Piotr GEIGY Nicolas KELLER Dagmar I. REICHLIN Tobias LOHRMANN Jens BISKUP Ewalina KLOOS Wanda LOPEZ Beatriz INOSTROZA Carolina Fuenzalida ADRADA Esther Rodriguez KAWECKI Damian MUZYK Piotr NOWALANY-KOZIELSKA Ewa PAŘENICA Jiří MEISSNER Kathrin KULANGARA Caroline MAHFOUZ Riham RENTSCH Katharina VON ECKARDSTEIN Arnold
Year of publication	2019
Type	Article in Periodical
Magazine / Source	International Journal of Cardiology
MU Faculty or unit	Faculty of Medicine
Citation
Web	http://dx.doi.org/10.1016/j.ijcard.2019.04.088
Doi	http://dx.doi.org/10.1016/j.ijcard.2019.04.088
Keywords	Biomarkers; Acute coronary syndromes; Mortality/survival
Description	Background: To assess the prognostic performance of Growth differentiation factor-15 (GDF-15) concentrations in unselected patients presenting with suspected acute myocardial infarction (AMI) and adjudication based on high-sensitivity cardiac troponin (hs-cTn). Methods and results: In an ongoing prospective multicenter diagnostic study, consecutive patients presenting with suspected AMI to the emergency department and available GDF-15 and hs-cTnT concentrations were included. Adjudication of AMI was performed central by two independent cardiologists using all available clinical information including cardiac imaging and serial hs-cTn concentrations. Overall, 718 patients were included, with 23% (162/718) having an adjudicated diagnosis of AMI. The cumulative incidence of death within 2 years was 19% in patients with AMI (30 deaths in 162 patients) versus 5% in patients without AMI (25 deaths in 556 patients; P < 0.001). In AMI patients, GDF-15 provided an AUC of 0.89 (95% confidence interval [CI] 0.83-0.94) for 2-year death versus 0.55 (95% CI 0.44-0.66) for hs-cTnT (P < 0.001). A GDF-15 cutoff of <= 1560 ng/L predicted 2-year survival in 47% (76/162) of AMI patients and had 100% sensitivity (95% CI 88-100%) for 2-year death. In patients without AMI, GDF-15 provided an AUC of 0.83 (95% CI 0.76-0.89) versus 0.76 (95% CI 0.67-0.85) for hscTnT (P= 0.096). A GDF-15 cutoff of <= 886 ng/L predicted 2-year survival in 37% (203/556) of non-AMI patients and had 100% sensitivity (95% CI 86-100%) for 2-year death. Conclusions: GDF-15 concentrations at emergency department presentation have a high predictive accuracy for all-cause death in patients with suspected AMI and allow the identification of a large proportion of AMI patients with very low mortality risk. (C) 2019 Elsevier B.V. All rights reserved.