title: Growth-differentiation factor-15 improves risk stratification in ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Growth-differentiation factor-15 (GDF-15) is a transforming growth factor-beta-related cytokine that is induced in the heart following ischaemia-reperfusion injury. We explored the prognostic utility of GDF-15 in patients with ST-segment elevation myocardial infarction (STEMI) receiving fibrinolytic therapy.
  
  
  RESULTS
  Circulating levels of GDF-15 were determined by an immunoradiometric assay in 741 STEMI patients who were included in the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT)-2 and ASSENT-plus trials. About 72.7% of the patients presented with GDF-15 levels > or =1200 ng/L, the upper limit of normal in apparently healthy elderly individuals. Increased levels of GDF-15 were associated with a higher risk of death during 1-year follow-up. Mortality rates at 1 year were 2.1, 5.0, and 14.0% in patients with GDF-15 levels <1200, 1200-1800, and >1800 ng/L, respectively (P < 0.001). GDF-15 remained an independent predictor of mortality after adjustment for clinical variables, troponin T, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). GDF-15 provided prognostic information in clinically relevant patient subgroups, defined according to age, gender, cardiovascular risk factors, haemodynamic status, and the TIMI risk score. Moreover, GDF-15 added prognostic information to the established biomarkers of adverse prognosis in STEMI, troponin T, and NT-proBNP.
  
  
  CONCLUSIONS
  GDF-15 is a new biomarker in STEMI that provides prognostic information beyond established clinical and biochemical markers.
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany.
authors.forename: Tibor
authors.initials: T
authors.lastname: Kempf
authors.forename: Erik
authors.initials: E
authors.lastname: Björklund
authors.forename: Sylvia
authors.initials: S
authors.lastname: Olofsson
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.forename: Tim
authors.initials: T
authors.lastname: Allhoff
authors.forename: Timo
authors.initials: T
authors.lastname: Peter
authors.forename: Jörn
authors.initials: J
authors.lastname: Tongers
authors.forename: Kai C
authors.initials: KC
authors.lastname: Wollert
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D055436:Growth Differentiation Factor 15; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D016207:Cytokines; C526140:GDF15 protein, human; D055436:Growth Differentiation Factor 15