入院时生长分化因子-15水平可为接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者的全因长期死亡率提供增量预后信息。
Growth Differentiation Factor-15 Levels at Admission Provide Incremental Prognostic Information on All-Cause Long-term Mortality in ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention.
作者信息
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
机构信息
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Clinical Chemistry and Laboratory Medicine, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Cardiol Ther. 2019 Jun;8(1):29-41. doi: 10.1007/s40119-019-0127-4. Epub 2019 Jan 30.
INTRODUCTION
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
引言
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。
方法
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。
结果
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。
结论
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。
Zotero 插件