Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway.
Clin Chem. 2023 Jun 1;69(6):649-660. doi: 10.1093/clinchem/hvad015.
Acute chest pain is associated with an increased risk of death and cardiovascular events even when acute myocardial infarction (AMI) has been excluded. Growth differentiation factor-15 (GDF-15) is a strong prognostic marker in patients with acute chest pain and AMI, but the prognostic value in patients without AMI is uncertain. This study sought to investigate the ability of GDF-15 to predict long-term prognosis in patients presenting with acute chest pain without AMI.
In total, 1320 patients admitted with acute chest pain without AMI were followed for a median of 1523 days (range: 4 to 2208 days). The primary end point was all-cause mortality. Secondary end points included cardiovascular (CV) death, future AMI, heart failure hospitalization, and new-onset atrial fibrillation (AF).
Higher concentrations of GDF-15 were associated with increased risk of death from all causes (median concentration in non-survivors vs survivors: 2124 pg/mL vs 852 pg/mL, P < 0.001), and all secondary end points. By multivariable Cox regression, GDF-15 concentration ≥4th quartile (compared to <4th quartile) remained an independent predictor of all-cause death (adjusted hazard ratio (HR): 2.75; 95% CI, 1.69-4.45, P < 0.001), CV death (adjusted HR: 3.74; 95% CI, 1.31-10.63, P = 0.013), and heart failure hospitalization (adjusted HR: 2.60; 95% CI, 1.11-6.06, P = 0.027). Adding GDF-15 to a model consisting of established risk factors and high-sensitivity cardiac troponin T (hs-cTnT) led to a significant increase in C-statistics for prediction of all-cause mortality.
Higher concentrations of GDF-15 were associated with increased risk of mortality from all causes and risk of future CV events.
即使急性心肌梗死（AMI）已被排除，急性胸痛仍与死亡和心血管事件风险增加相关。生长分化因子-15（GDF-15）是急性胸痛伴 AMI 患者的一个强有力的预后标志物，但在非 AMI 患者中的预后价值尚不确定。本研究旨在探讨 GDF-15 预测急性胸痛但无 AMI 患者长期预后的能力。
共纳入 1320 例因急性胸痛而住院但无 AMI 的患者，中位随访时间为 1523 天（范围：4 至 2208 天）。主要终点为全因死亡率。次要终点包括心血管（CV）死亡、未来 AMI、心力衰竭住院和新发心房颤动（AF）。
较高的 GDF-15 浓度与全因死亡风险增加相关（非幸存者与幸存者的中位数浓度：2124pg/ml 与 852pg/ml，P＜0.001），且与所有次要终点均相关。多变量 Cox 回归分析显示，GDF-15 浓度≥第 4 四分位数（与＜第 4 四分位数相比）仍然是全因死亡的独立预测因素（校正后的危险比（HR）：2.75；95%置信区间，1.69-4.45，P＜0.001）、CV 死亡（校正 HR：3.74；95%置信区间，1.31-10.63，P=0.013）和心力衰竭住院（校正 HR：2.60；95%置信区间，1.11-6.06，P=0.027）。将 GDF-15 加入由既定风险因素和高敏心肌肌钙蛋白 T（hs-cTnT）组成的模型中，可显著提高全因死亡率预测的 C 统计量。
较高的 GDF-15 浓度与全因死亡风险增加和未来 CV 事件风险相关。
