According to a new study, elevated levels of growth differentiation factor-15 (GDF-15), a marker of oxidative stress and inflammation, are significantly associated with higher 30- and 90-day risks of death or acute myocardial infarction in adults presenting with suspected acute coronary syndrome (ACS). Even after adjusting for troponin and NT-proBNP, higher GDF-15 levels predicted worse outcomes, suggesting its potential role in risk stratification and guiding patient management in the emergency department. The study was published in the Journal of the American Heart Association by Bryn E. and colleagues.
The study was a secondary analysis of the STOP-CP (High Sensitivity Cardiac Troponin T to Optimize Chest Pain Risk Stratification) trial, which was performed in eight emergency departments in the United States between 2017 and 2018. A total of 1,428 adults aged 21 years or older who had suspected acute myocardial infarction were included. Out of the included participants, the median age was 58 years (interquartile range: 49–66 years), and 25% (353 individuals) had coronary artery disease.
High-sensitivity troponin T, BNP, and GDF-15 were assessed at baseline and at 3 hours. The primary outcome of the study was a composite of all-cause death or AMI at three time points: at index visit, 30 days, and 90 days.
Key Findings
• Among 1,428 patients under study, the composite endpoint of death or AMI was seen in 169 patients (12%) at the index visit, with 21 cases (1.5%) happening at 30 days and 27 cases (1.9%) at 90 days.
• In multivariable logistic regression analyses adjusted for age, sex, cardiac risk factors, ischemic ECG changes, troponin T, and BNP, GDF-15 was identified as an independent predictor of worse outcomes at later times.
• GDF-15 at 30 days was independently linked with all-cause death or AMI with an adjusted odds ratio (aOR) per standard deviation (SD) of 1.27 (95% CI: 1.06–1.54).
• By 90 days, the association was strengthened, at an aOR per SD of 1.55 (95% CI: 1.26–1.94).
• At the index visit, however, GDF-15 was not significantly associated (aOR per SD: 1.00; 95% CI: 0.83–1.16).
The study proves that GDF-15 is a significant and independent biomarker for the prediction of 30-day and 90-day all-cause death or myocardial infarction in adults presenting to emergency departments with suspected acute coronary syndromes. These findings indicate that the inclusion of GDF-15 in models of cardiac risk may strengthen post-discharge surveillance and enhance patient management approaches for chest pain assessment.
Reference:
Mumma, B. E., Bhandari, N., Tran, N. K., Ford, J. S., Christenson, R., Wilkerson, R. G., Madsen, T., Weaver, M. T., Yi, F., Zhang, X., Allen, B. R., & Mahler, S. A. (2025). Growth differentiation factor-15 is associated with acute myocardial infarction and death at 30 and 90 days in emergency department patients with suspected acute coronary syndrome. Journal of the American Heart Association, e038675, e038675.https://doi.org/10.1161/JAHA.124.038675
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