Document Detail


Growth differentiation factor 15 for risk stratification and selection of an invasive treatment strategy in non ST-elevation acute coronary syndrome.
MedLine Citation:
PMID:  17848615     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: An invasive treatment strategy improves outcome in patients with non-ST-elevation acute coronary syndrome at moderate to high risk. We hypothesized that the circulating level of growth differentiation factor 15 (GDF-15) may improve risk stratification. METHODS AND RESULTS: The Fast Revascularization during InStability in Coronary artery disease II (FRISC-II) trial randomized patients with non-ST-elevation acute coronary syndrome to an invasive or conservative strategy with a follow-up for 2 years. GDF-15 and other biomarkers were determined on admission in 2079 patients. GDF-15 was moderately elevated (between 1200 and 1800 ng/L) in 770 patients (37.0%), and highly elevated (>1800 ng/L) in 493 patients (23.7%). Elevated levels of GDF-15 independently predicted the risk of the composite end point of death or recurrent myocardial infarction in the conservative group (P=0.016) but not in the invasive group. A significant interaction existed between the GDF-15 level on admission and the effect of treatment strategy on the composite end point. The occurrence of the composite end point was reduced by the invasive strategy at GDF-15 levels >1800 ng/L (hazard ratio, 0.49; 95% confidence interval, 0.33 to 0.73; P=0.001), between 1200 and 1800 ng/L (hazard ratio, 0.68; 95% confidence interval, 0.46 to 1.00; P=0.048), but not <1200 ng/L (hazard ratio, 1.06; 95% confidence interval, 0.68 to 1.65; P=0.81). Patients with ST-segment depression or a troponin T level >0.01 microg/L with a GDF-15 level <1200 ng/L did not benefit from the invasive strategy. CONCLUSIONS: GDF-15 is a potential tool for risk stratification and therapeutic decision making in patients with non-ST-elevation acute coronary syndrome as initially diagnosed by ECG and troponin levels. A prospective randomized trial is needed to validate these findings.
Authors:
Kai C Wollert; Tibor Kempf; Bo Lagerqvist; Bertil Lindahl; Sylvia Olofsson; Tim Allhoff; Timo Peter; Agneta Siegbahn; Per Venge; Helmut Drexler; Lars Wallentin
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-09-11
Journal Detail:
Title:  Circulation     Volume:  116     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-02     Completed Date:  2007-11-19     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1540-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiology and Angiology, Hannover University Medical School, Hannover, Germany.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Aged
Biological Markers / blood*
Coronary Artery Disease / blood*,  diagnosis,  epidemiology,  therapy*
Cytokines / blood*
Electrocardiography*
Female
Growth Differentiation Factor 15
Humans
Male
Middle Aged
Myocardial Revascularization
Risk Factors
Treatment Outcome
Troponin T / blood
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Cytokines; 0/GDF15 protein, human; 0/Growth Differentiation Factor 15; 0/Troponin T

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