Growth Differentiation Factor 15: A Prognostic Marker in Patients with Acute Chest Pain without Acute Myocardial Infarction

• Published in: Clinical chemistry (Baltimore, Md.) Vol. 69; no. 6; pp. 649 - 660
• Main Authors: Myrmel, Gard M S, Steiro, Ole-Thomas, Tjora, Hilde L, Langørgen, Jørund, Bjørneklett, Rune, Skadberg, Øyvind, Bonarjee, Vernon V S, Mjelva, Øistein R, Pedersen, Eva K R, Vikenes, Kjell, Omland, Torbjørn, Aakre, Kristin M
• Format: Journal Article
• Language: English; Norwegian
• Published: US Oxford University Press 01.06.2023
• Subjects: Biomarkers; Chest Pain; Growth Differentiation Factor 15; Heart Failure - diagnosis; Humans; Myocardial Infarction - diagnosis; Prognosis; Prospective Studies
• ISSN: 0009-9147; 1530-8561
• DOI: 10.1093/clinchem/hvad015

Abstract Background Acute chest pain is associated with an increased risk of death and cardiovascular events even when acute myocardial infarction (AMI) has been excluded. Growth differentiation factor-15 (GDF-15) is a strong prognostic marker in patients with acute chest pain and AMI, but the prognostic value in patients without AMI is uncertain. This study sought to investigate the ability of GDF-15 to predict long-term prognosis in patients presenting with acute chest pain without AMI. Methods In total, 1320 patients admitted with acute chest pain without AMI were followed for a median of 1523 days (range: 4 to 2208 days). The primary end point was all-cause mortality. Secondary end points included cardiovascular (CV) death, future AMI, heart failure hospitalization, and new-onset atrial fibrillation (AF). Results Higher concentrations of GDF-15 were associated with increased risk of death from all causes (median concentration in non-survivors vs survivors: 2124 pg/mL vs 852 pg/mL, P < 0.001), and all secondary end points. By multivariable Cox regression, GDF-15 concentration ≥4th quartile (compared to <4th quartile) remained an independent predictor of all-cause death (adjusted hazard ratio (HR): 2.75; 95% CI, 1.69–4.45, P < 0.001), CV death (adjusted HR: 3.74; 95% CI, 1.31–10.63, P = 0.013), and heart failure hospitalization (adjusted HR: 2.60; 95% CI, 1.11–6.06, P = 0.027). Adding GDF-15 to a model consisting of established risk factors and high-sensitivity cardiac troponin T (hs-cTnT) led to a significant increase in C-statistics for prediction of all-cause mortality. Conclusions Higher concentrations of GDF-15 were associated with increased risk of mortality from all causes and risk of future CV events.