Abstract 17342: Growth-Differentiation Factor-15 as Predictor of Mortality in Acute Reperfused ST-Elevation Myocardial Infarction: Insights from Cardiovascular Magnetic Resonance
Objective: Levels of growth differentiation factor (GDF)-15, a stress-responsive member of the transforming growth factor-b cytokine superfamily, predict outcomes in cardiovascular disease. However, the exact pathophysiological mechanisms of GDF-15 in the cardiovascular system and in acute ST-elevation myocardial infarction (STEMI) are not well defined. The aim of this study was to determine the relation between GDF-15 and myocardial damage (infarct size, myocardial salvage, microvascular obstruction) assessed by cardiovascular magnetic resonance (CMR) imaging and to evaluate the prognostic value of GDF-15 in a high-risk STEMI population exclusively reperfused by primary angioplasty.
Methods: GDF-15 levels were determined by an enzyme-linked immunoabsorbent assay in 238 consecutive patients undergoing primary angioplasty in STEMI <12 hours after symptom onset. Patients were categorized into 2 groups defined by the median GDF-15 value on admission. CMR was performed for assessment of infarct size, myocardial salvage and microvascular obstruction. The primary clinical endpoint was mortality within 6 months after the index event.
Results: Elevated GDF-15 levels ≥ median on admission were a strong predictor of mortality (19 versus 1 death, p<0.001) and major adverse cardiac events (27 versus 9 events, p=0.001) at 6-months follow-up. GDF-15 levels on admission were inversely correlated with myocardial salvage, but showed no association with other established prognostic markers in STEMI patients including infarct size, microvascular obstruction, pain-to-balloon time, TIMI-flow before and after PCI as well as ST-resolution.
Conclusions: GDF-15 on admission is a strong predictor of mortality in patients with STEMI reperfused by primary angioplasty, which is associated with decreased myocardial salvage and subsequent adverse clinical outcome.
- © 2010 by American Heart Association, Inc.