Abstract | BACKGROUND: Growth differentiation factor-15 (GDF-15) is a stress-responsive marker that might aid in the early diagnosis and risk stratification of patients with suspected acute myocardial infarction (AMI). METHODS: In a prospective, international multicenter study, GDF-15, high-sensitivity cardiac troponin T (hs-cTnT), and B-type natriuretic peptide (BNP) were measured in 646 unselected patients presenting to the emergency department with acute chest pain. The final diagnosis was adjudicated by 2 independent cardiologists. The primary prognostic end point was all-cause mortality during a median follow-up of 26 months. RESULTS: AMI was the adjudicated final diagnosis in 115 patients (18%). GDF-15 concentrations at presentation were significantly higher in AMI patients compared to patients with other diagnoses. The diagnostic accuracy of GDF-15 at presentation for the diagnosis of AMI as quantified by the area under the ROC curve (AUC) was lower (AUC 0.69, 95% CI 0.64-0.74) compared to hs-cTnT (AUC 0.96, 95% CI 0.94-0.98, P < 0.001) and BNP (AUC 0.74, 95% CI 0.69-0.80, P = 0.02). A total of 55 deaths occurred during follow-up. GDF-15 predicted all-cause mortality independently of and more accurately than hs-cTnT [AUC 0.85 (95% CI 0.81-0.90) vs 0.77 (95% CI 0.72-0.83), P = 0.002] and BNP (AUC 0.75, 95% CI 0.68-0.82, P = 0.007). Net reclassification improvement was 0.15 (P = 0.01), and the absolute integrated discrimination improvement was 0.07, yielding a relative integrated discrimination improvement of 0.36 (P = 0.07). CONCLUSIONS:
GDF-15 predicts all-cause mortality in unselected patients with acute chest pain independently of and more accurately than hs-cTnT and BNP. However, GDF-15 does not seem to help in the early diagnosis of AMI.
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Authors | Nora Schaub, Tobias Reichlin, Raphael Twerenbold, Miriam Reiter, Stephan Steuer, Stefano Bassetti, Claudia Stelzig, Claudia Wolf, Katrin Winkler, Philip Haaf, Julia Meissner, Beatrice Drexler, Christian Mueller |
Journal | Clinical chemistry
(Clin Chem)
Vol. 58
Issue 2
Pg. 441-9
(Feb 2012)
ISSN: 1530-8561 [Electronic] England |
PMID | 22205695
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Chemical References |
- Biomarkers
- Growth Differentiation Factor 15
- Troponin T
- Natriuretic Peptide, Brain
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Topics |
- Acute Disease
- Aged
- Aged, 80 and over
- Angina, Unstable
(diagnosis)
- Biomarkers
(blood)
- Chest Pain
(diagnosis, mortality)
- Early Diagnosis
- Female
- Growth Differentiation Factor 15
(blood)
- Humans
- Male
- Middle Aged
- Mortality
- Myocardial Infarction
(diagnosis)
- Natriuretic Peptide, Brain
(blood)
- Prognosis
- Prospective Studies
- Risk Assessment
- Troponin T
(blood)
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