Abstract 2067: Prognostic Value of Growth-Differentiation Factor-15 in Patients with ST-Elevation Myocardial Infarction
Growth-differentiation factor-15 (GDF-15) is a member of the TGF-β cytokine superfamily that is induced in the heart after experimental myocardial infarction. To determine if circulating levels of GDF-15 provide prognostic information in patients with ST-elevation myocardial infarction (STEMI), we developed and extensively validated an immunoradiometric assay (IRMA) using a polyclonal, GDF-15 affinity chromatography-purified, goat anti-human GDF-15 IgG antibody. Blood samples were obtained at study entry from 195 patients with acute chest pain and significant ST-elevations or left bundle branch block that were included in the ASSENT-PLUS trial (66.2% male, median age 66 years) and from a matching cohort of 429 healthy, elderly individuals (67.1% male, median age 65 years). Levels of the established biomarkers troponin T and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were also determined. Patients with STEMI had elevated GDF-15 levels as compared to healthy controls [median (rounded tertiles): 1564 (1200 to 1800) ng/L vs. median (rounded 90th percentile): 762 (1200) ng/L; P<0.001]. GDF-15 levels in the top tertile (>1800 ng/L) identified a subgroup of patients with a very high mortality and adverse clinical outcomes (Table⇓). By univariable Cox regression analysis, age and the levels of troponin T, NT-proBNP, and GDF-15 (but not gender or diabetes mellitus) were related to mortality or the composite endpoint of mortality and myocardial infarction. Using a multivariable approach, only age (P=0.030) and GDF-15 (P=0.032) were related to the composite endpoint, and only GDF-15 (P=0.003) to 1 year mortality.
In conclusion, GDF-15 is a new powerful biomarker of adverse outcome in STEMI patients that appears to provide prognostic information beyond established clinical and biochemical markers.