title: Growth-differentiation factor-15 for early risk stratification in patients with acute chest pain.
abstract: OBJECTIVE
  Growth-differentiation factor-15 (GDF-15) has emerged as a biomarker of increased mortality and recurrent myocardial infarction (MI) in patients diagnosed with non-ST-elevation acute coronary syndrome. We explored the usefulness of GDF-15 for early risk stratification in 479 unselected patients with acute chest pain.
  
  
  RESULTS
  Sixty-nine per cent of the patients presented with GDF-15 levels above the previously defined upper reference limit (1200 ng/L). The risks of the composite endpoint of death or (recurrent) MI after 6 months were 1.3, 5.1, and 12.6% in patients with normal (<1200 ng/L), moderately elevated (1200-1800 ng/L), or markedly elevated (>1800 ng/L) levels of GDF-15 on admission, respectively (P < 0.001). By multivariable analysis that included clinical characteristics, ECG findings, peak cardiac troponin I levels within 2 h (cTnI(0-2 h)), N-terminal pro-B-type natriuretic peptide, C-reactive protein, and cystatin C, GDF-15 remained an independent predictor of the composite endpoint. The ability of the ECG combined with peak cTnI(0-2 h) to predict the composite endpoint was markedly improved by addition of GDF-15 (c-statistic, 0.74 vs. 0.83; P < 0.001).
  
  
  CONCLUSIONS
  GDF-15 improves risk stratification in unselected patients with acute chest pain and provides prognostic information beyond clinical characteristics, the ECG, and cTnI.
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Kai M
authors.initials: KM
authors.lastname: Eggers
authors.forename: Tibor
authors.initials: T
authors.lastname: Kempf
authors.forename: Tim
authors.initials: T
authors.lastname: Allhoff
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.forename: Kai C
authors.initials: KC
authors.lastname: Wollert
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014218:Triage; D019210:Troponin I / Q000378:metabolism
chemical_list: D015415:Biomarkers; D055436:Growth Differentiation Factor 15; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein