Dominguez-Rodriguez Alberto, Abreu-Gonzalez Pedro, Avanzas Pablo, Consuegra-Sanchez Luciano
Hospital Universitario de Canarias, Servicio de Cardiología, Santa Cruz de Tenerife, Spain; Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain.
Departamento de Ciencias Medicas Básicas (Unidad de Fisiología), Universidad de La Laguna, Santa Cruz de Tenerife, Spain.
Am J Cardiol. 2016 May 15;117(10):1569-1574. doi: 10.1016/j.amjcard.2016.02.031. Epub 2016 Mar 2.
Growth differentiation factor-15 (GDF-15) is produced by cardiomyocytes and atherosclerotic lesions under stress conditions, but little is known about its relation with severity and complexity of coronary lesions. The aim of this study was to investigate the association between GDF-15 and the syntax score for risk prediction of major adverse cardiovascular events (MACE) at 2-year follow-up in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). This is a prospective cohort study of 502 patients with NSTEACS. The syntax score was calculated from baseline coronary angiography. Blood samples were obtained at study entry for the assessment of GDF-15 and high-sensitivity C reactive protein. One hundred and three patients (20.5%) showed MACE at 2-year follow-up. Patients who developed MACE had greater GDF-15 concentrations and syntax score (p <0.001) compared to patients who did not. There was a positive, but moderate, correlation between GDF-15 and syntax score (ρ = 0.45, p <0.0001). On Cox regression analysis, only GDF-15 levels (p <0.001), body mass index (p = 0.04), and syntax score (p <0.001) remained independent predictors of the MACE. The area under the curve of GDF-15 (0.912, 95% confidence interval 0.894 to 0.944) was significantly greater compared to high-sensitivity C reactive protein and syntax score. In conclusion, in patients with NSTEACS, levels of GDF-15 at admission were correlated with the syntax score and independently associated with an increased risk of MACE during 2-year follow-up.
生长分化因子15（GDF - 15）在应激条件下由心肌细胞和动脉粥样硬化病变产生，但对其与冠状动脉病变严重程度和复杂性的关系知之甚少。本研究旨在探讨非ST段抬高型急性冠状动脉综合征（NSTEACS）患者中，GDF - 15与2年随访时主要不良心血管事件（MACE）风险预测的SYNTAX评分之间的关联。这是一项对502例NSTEACS患者的前瞻性队列研究。SYNTAX评分根据基线冠状动脉造影计算得出。在研究入组时采集血样，用于评估GDF - 15和高敏C反应蛋白。103例患者（20.5%）在2年随访时出现MACE。与未发生MACE的患者相比，发生MACE的患者GDF - 15浓度和SYNTAX评分更高（p <0.001）。GDF - 15与SYNTAX评分之间存在正相关，但相关性中等（ρ = 0.45，p <0.0001）。在Cox回归分析中，只有GDF - 15水平（p <0.001）、体重指数（p = 0.04）和SYNTAX评分（p <0.001）仍然是MACE的独立预测因素。GDF - 15的曲线下面积（0.912，95%置信区间0.894至0.944）显著大于高敏C反应蛋白和SYNTAX评分。总之，在NSTEACS患者中，入院时GDF - 15水平与SYNTAX评分相关，并且在2年随访期间与MACE风险增加独立相关。
