Bodde Mathijs C, Hermans Maaike P J, van der Laarse Arnoud, Mertens Bart, Romijn Fred P H T M, Schalij Martin J, Cobbaert Christa M, Jukema J Wouter
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
Cardiol Ther. 2019 Jun;8(1):29-41. doi: 10.1007/s40119-019-0127-4. Epub 2019 Jan 30.
To investigate the additive prognostic value of growth differentiation factor (GDF-15) levels in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneously coronary intervention (pPCI) with 10-year mortality on top of clinical characteristics and known cardiac biomarkers.
Baseline serum GDF-15 levels were measured in 290 STEMI patients treated with pPCI in the MISSION! intervention trial conducted from February 1, 2004 through October 31, 2006. The incremental prognostic value of GDF-15 and NTproBNP levels was evaluated on top of clinical characteristics using Cox proportional hazards analysis, Chi-square models and C-index. Outcome was 10-year all-cause mortality.
Mean age was 59.0 ± 11.5 years and 65 (22.4) patients were female. A total of 37 patients died during a follow-up of 9.4 (IQR 8.8-10.0) years. Multivariable Cox regression revealed GDF-15 and NTproBNP levels above median to be independently associated with 10-year all-cause mortality [HR GDF-15, 2.453 (95% CI 1.064-5.658), P = 0.04; HR NTproBNP, 2.413 (95% CI 1.043-5.564), P = 0.04] after correction for other clinical variables. Stratified by median GDF-15 (37.78 pmol/L) and NTproBNP (11.74 pmol/L) levels, Kaplan-Meier curves showed significant better survival for patients with GDF-15 and NTproBNP levels below the median versus above the median. The likelihood ratio test showed a significant incremental value of GDF-15 (P = 0.03) as compared with a model with clinically important variables and NTproBNP. The C-statistics for this model improved from 0.82 to 0.84 when adding GDF-15.
GDF-15 levels at admission in STEMI patients are independently associated with 10-year all-cause mortality rates and could improve risk stratification on top of clinical variables and other cardiac biomarkers.
探讨生长分化因子（GDF-15）水平对接受直接经皮冠状动脉介入治疗（pPCI）的ST段抬高型心肌梗死（STEMI）患者10年死亡率的附加预后价值，评估其在临床特征和已知心脏生物标志物基础上的作用。
在“MISSION！”干预试验中，对290例接受pPCI治疗的STEMI患者测量基线血清GDF-15水平。该试验于2004年2月1日至2006年10月31日进行。使用Cox比例风险分析、卡方模型和C指数，在临床特征基础上评估GDF-15和NTproBNP水平的增量预后价值。结局指标为10年全因死亡率。
平均年龄为59.0±11.5岁，65例（22.4%）为女性。在9.4（四分位间距8.8 - 10.0）年的随访期间，共有37例患者死亡。多变量Cox回归显示，校正其他临床变量后，GDF-15和NTproBNP水平高于中位数与10年全因死亡率独立相关[GDF-15的风险比（HR）为2.453（95%置信区间1.064 - 5.658），P = 0.04；NTproBNP的HR为2.413（95%置信区间1.043 - 5.564），P = 0.04]。根据GDF-15中位数（37.78 pmol/L）和NTproBNP中位数（11.74 pmol/L）水平分层，Kaplan-Meier曲线显示，GDF-15和NTproBNP水平低于中位数的患者生存率显著高于高于中位数的患者。似然比检验显示，与包含临床重要变量和NTproBNP的模型相比，GDF-15具有显著的增量价值（P = 0.03）。添加GDF-15后，该模型的C统计量从0.82提高到0.84。
STEMI患者入院时的GDF-15水平与10年全因死亡率独立相关，并且在临床变量和其他心脏生物标志物基础上可改善风险分层。
