Growth Differentiation Factor-15 is Associated With Acute Myocardial Infarction and Death at 30 and 90Days in Emergency Department Patients With Suspected Acute Coronary Syndrome

Abstract

BACKGROUND: Growth differentiation factor-15 (GDF-15) is a novel biomarker of cardiac stress. GDF-15 may be a stronger predictor of all-cause death in patients with acute chest pain than traditional biomarkers such as high-sensitivity troponin T and BNP (B-type natriuretic peptide). However, data from US populations are lacking. Our objective was to determine whether GDF-15 is an independent predictor of all-cause death or acute myocardial infarction (AMI) at index visit, 30days, and 90days. METHODS: We conducted a secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) trial, which prospectively enrolled adults (aged ≥21years) from 8 US emergency departments with suspected AMI in 2017 to 2018. High-sensitivity troponin T, BNP, and GDF-15 assays were performed at a central laboratory on samples from baseline and 3hours later. The primary outcome was the composite of all-cause death or AMI at index visit, 30days, and 90days. Multiple logistic regression models assessed the association between GDF-15 and all-cause death or AMI at index visit, as well as at 30 and 90days, while adjusting for age, sex, number of cardiac risk factors, ischemic ECG findings, high-sensitivity troponin T, and N-terminal pro-B-type natriuretic peptide. RESULTS: We studied 1428 patients; median age was 58 (interquartile range, 49–66) years and 353 (25%) had a history of coronary artery disease. The composite outcome of all-cause death or AMI occurred in 169 (12%) patients at index visit, an additional 21 (1.5%) at 30days, and an additional 27 (1.9%) at 90days. In multiple logistic regression models, GDF-15 was independently associated with all-cause death or AMI at 30days (adjusted odds ratio per SD, 1.27 [95% CI, 1.06–1.54]) and 90days (adjusted odds ratio R per SD, 1.55 [95% CI, 1.26–1.94]), but not during the index visit (adjusted odds ratio per SD, 1.00 [95% CI, 0.83–1.16]). CONCLUSIONS: Among adult emergency department patients with suspected AMI, GDF-15 was independently associated with subsequent 30-day and 90-day all-cause death or AMI. These data suggest a potential role for GDF-15 in short-term cardiac risk stratification in emergency department patients without AMI at index visit.