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Prognostic role of GDF-15 across the spectrum of clinical risk in patients with NSTE-ACS.
Zelniker, Thomas A; Jarolim, Petr; Silverman, Michael G; Bohula, Erin A; Park, Jeong-Gun; Bonaca, Marc P; Scirica, Benjamin M; Morrow, David A.
Afiliação
  • Zelniker TA; TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Jarolim P; Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Silverman MG; Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
  • Bohula EA; TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Park JG; TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Bonaca MP; TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Scirica BM; TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • Morrow DA; TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Clin Chem Lab Med ; 57(7): 1084-1092, 2019 06 26.
Article em En | MEDLINE | ID: mdl-30710475
ABSTRACT
Background Growth differentiation factor (GDF)-15 has been shown to predict cardiovascular (CV) outcomes in acute coronary syndrome (ACS) using non-commercial assays. We evaluated the prognostic performance of GDF-15 measured with the first clinically available assay. Furthermore, we evaluated whether GDF-15 was associated with CV death or heart failure (HF) across the spectrum of risk in non-ST-segment elevation (NSTE)-ACS. Methods We measured baseline GDF-15 (Roche, Elecsys) in 4330 patients with NSTE-ACS enrolled in MERLIN-TIMI 36. Patients were categorized using a priori thresholds of GDF-15 levels (<1200, 1200-1800, ≥1800 ng/L) and stratified according to estimated clinical risk per TIMI risk score (0-2, 3-4, and ≥5). Cox modeling included age, sex, BMI, smoking, HF, diabetes, renal function, NT-proBNP, hsTnT, and hsCRP. Results There were 2286 (53%), 1104 (25%), and 940 (22%) pts with GDF-15 <1200, 1200-1800, and ≥1800 respectively. GDF-15 was significantly associated after multivariable adjustment with CV death/HF modeled either as a categorical (1200-1800 ng/L Adj hazard ratios [HR] 1.55 [1.09-2.19]; ≥1800 ng/L Adj HR 1.94 [1.34-2.79]) or continuous variable (Adj HR 1.36 [1.16-1.60] per 1-unit increase in log2-transformed GDF-15). Notably, there was an interaction (Pinteraction=0.003) between TIMI risk score and GDF-15, with GDF-15 identifying the greatest incremental relative risk in those at lowest risk based on the TIMI risk score alone. Conclusions Using a clinically available assay, GDF-15 can be applied using established cut-off points to independently predict risk of CV death/HF in patients with NSTE-ACS. This incremental risk appears to be particularly robust among individuals traditionally identified as low risk.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome Coronariana Aguda / Fator 15 de Diferenciação de Crescimento Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Chem Lab Med Assunto da revista: QUIMICA CLINICA / TECNICAS E PROCEDIMENTOS DE LABORATORIO Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Síndrome Coronariana Aguda / Fator 15 de Diferenciação de Crescimento Tipo de estudo: Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Chem Lab Med Assunto da revista: QUIMICA CLINICA / TECNICAS E PROCEDIMENTOS DE LABORATORIO Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Estados Unidos