title: Growth-differentiation factor 15 for long-term prognostication in patients with non-ST-elevation acute coronary syndrome: an Invasive versus Conservative Treatment in Unstable coronary Syndromes (ICTUS) substudy.
abstract: BACKGROUND
  No five-year long-term follow-up data is available regarding the prognostic value of GDF-15. Our aim is to evaluate the long-term prognostic value of admission growth-differentiation factor 15 (GDF-15) regarding death or myocardial infarction (MI) in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).
  
  
  METHODS
  This is a subanalysis from the ICTUS (Invasive versus Conservative Treatment in Unstable coronary Syndromes) trial, including troponin positive NSTE-ACS patients. The main outcome for the current analysis was 5-year death or spontaneous MI. GDF-15 samples were available in 1151 patients. The prognostic value of GDF-15, categorized into <1200 ng/L, 1200-1800 ng/L and >1800 ng/L, was assessed in unadjusted and adjusted Cox regression models. Adjustments were made for identified univariable risk factors. The additional discriminative and reclassification value of GDF-15 beyond the independent risk factors was assessed by the category-free net reclassification improvement (1/2 NRI(>0)) and the integrated discrimination improvement (IDI) RESULTS: Compared to GDF-15<1200 ng/L, a GDF-15>1800 ng/L was associated with an increased hazard ratio for death or spontaneous MI, mainly driven by mortality. GDF-15 levels were predictive after adjustments for other identified predictors. Additional discriminative value was shown with the IDI, not with the NRI.
  
  
  CONCLUSIONS
  In patients presenting with NSTE-ACS and elevated troponin T, GDF-15 provides prognostic information in addition to identified predictors for mortality and spontaneous MI and can be used to identify patients at high risk during long-term follow-up.
authors: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors: Peter
authors: P
authors: Damman
authors: Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors: Tibor
authors: T
authors: Kempf
authors: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors: Fons
authors: F
authors: Windhausen
authors: Department of Clinical Chemistry, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors: Jan P
authors: JP
authors: van Straalen
authors: Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors: Anja
authors: A
authors: Guba-Quint
authors: Department of Clinical Chemistry, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors: Johan
authors: J
authors: Fischer
authors: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors: Jan G P
authors: JG
authors: Tijssen
authors: Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors: Kai C
authors: KC
authors: Wollert
authors: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands. Electronic address: r.j.dewinter@amc.uva.nl.
authors: Robbert J
authors: RJ
authors: de Winter
authors: Department of Cardiology, Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
authors: Alexander
authors: A
authors: Hirsch
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000401:mortality / Q000628:therapy; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; D055436:Growth Differentiation Factor 15; D020107:Troponin T
keywords: Growth-differentiation factor 15; Long-term outcomes; Non-ST-elevation acute coronary syndrome