title: Growth-differentiation factor 15 and osteoprotegerin in acute myocardial infarction complicated by cardiogenic shock: a biomarker substudy of the IABP-SHOCK II-trial.
abstract: OBJECTIVE
  This study investigates the role of osteoprotegerin (OPG) and growth-differentiation factor 15 (GDF-15) as predictors of outcome in cardiogenic shock (CS) complicating acute myocardial infarction. The novel biomarkers OPG and GDF-15 have shown prognostic impact in various cardiovascular diseases including myocardial infarction. In acute myocardial infarction complicated by CS, the diagnostic and prognostic impact of these biomarkers has not been investigated yet. OPG and GDF-15 may have additional prognostic impact on early prognosis assessment, being potentially useful for decision-making in CS.
  
  
  RESULTS
  In the randomized Intra-aortic Balloon Pump in cardiogenic Shock II (IABP-SHOCK II)-trial, 600 patients with CS complicating acute myocardial infarction undergoing early revascularization were assigned to therapy with or without IABP. Within a pre-defined substudy, blood samples were collected from 190 patients during PCI. GDF-15 and OPG serum levels were measured with standard enzyme-linked immunosorbent assay kits. Patients with GDF-15 and OPG levels greater than the median showed higher rates of death at 30 days by χ(2) testing (OPG, 51% vs. 32%, P = 0.01; GDF-15, 52% vs. 31%, P = 0.005) and log rank testing [GDF-15, hazard ratio (HR) 1.88, 95% confidence interval (CI) 1.21-2.94; P = 0.005; OPG, HR 1.74, 95% CI 1.11-2.71; P = 0.01]. Both markers were significantly predictive of 30-day mortality in univariable logistic regression analysis. In a multivariable logistic stepwise regression model, GDF-15, TIMI (Thrombolysis In Myocardial Infarction) flow grade <3 after PCI, age, LVEF, and serum lactate remained significant predictors of 30-day mortality.
  
  
  CONCLUSIONS
  GDF-15 on admission is a significant independent predictor of short-term mortality in infarct-related CS. Trail registration: NCT00491036.
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Fuernau
authors.forename: Christian
authors.initials: C
authors.lastname: Poenisch
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Volker
authors.initials: V
authors.lastname: Adams
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D055436:Growth Differentiation Factor 15 / Q000097:blood*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality; D053244:Osteoprotegerin / Q000097:blood*; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000097:blood* / Q000209:etiology / Q000401:mortality
chemical_list: D015415:Biomarkers; C526140:GDF15 protein, human; D055436:Growth Differentiation Factor 15; D053244:Osteoprotegerin; C506030:TNFRSF11B protein, human
keywords: Cardiogenic shock; Growth-differentiation factor 15; Myocardial infarction; Osteoprotegerin; Prognosis