Growth-Differentiation Factor-15 for Risk Stratification in Patients With Stable and Unstable Coronary Heart Disease Results From the AtheroGene Study
Growth-Differentiation Factor-15 for Risk Stratification in Patients With Stable and Unstable Coronary Heart Disease Results From the AtheroGene Study
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DOI：
10.1161/circgenetics.108.824870
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发表时间：
2009-06-01
影响因子：
--
通讯作者：
Wollert, Kai C.
中科院分区：
文献类型：
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作者：
Kempf, Tibor;Sinning, Jan-Malte;Wollert, Kai C.
背景-生长分化因子-15（GDF-15）是一种应激反应性转化生长因子-β相关细胞因子，已成为急性冠状动脉综合征试验人群的预后生物标志物。它的预测作用，在稳定型冠心病（CHD）从未被assessed.Methods和Results-The循环水平的GDF-15测定免疫放射分析在稳定型心绞痛（n = 1352）或急性冠状动脉综合征（n = 877）的患者进行了随访，中位数为3.6年。GDF-15水平正常（1800 ng/L）的稳定型心绞痛患者3.6年CHD死亡率分别为1.4%、2.7%和15.0%（P < 0.001）。Cox回归分析显示，GDF-15仍是CHD死亡率的独立预测因子（P < 0.001）。添加GDF-15改善了关于CHD死亡率的临床风险预测模型的预后准确性（c-统计量，0.84对0.74; P = 0.005）。对研究人群中急性冠状动脉综合征部分的分析证实GDF-15是CHD死亡率的独立预测因子（P < 0.001）。GDF-15的循环水平并不能预测稳定型心绞痛或急性冠状动脉综合征患者未来发生非致命性心肌梗死的风险。结论本研究确定GDF-15作为一个强大的和独立的预测冠心病死亡率在广泛的稳定和不稳定的冠心病患者。(Circ Genet. 2009; 2：286-292.）
Background-Growth-differentiation factor-15 (GDF-15) is a stress-responsive transforming growth factor-beta-related cytokine that has emerged as a prognostic biomarker in acute coronary syndrome trial populations. Its predictive role in stable coronary heart disease (CHD) has never been assessed.Methods and Results-The circulating levels of GDF-15 were measured by immunoradiometric assay in patients with stable angina pectoris (n = 1352) or acute coronary syndrome (n = 877) who were followed up for a median of 3.6 years. Stable angina pectoris patients presenting with normal (1800 ng/L) GDF-15 levels had 3.6-year CHD mortality rates of 1.4%, 2.7%, and 15.0%, respectively (P < 0.001). By backward stepwise Cox-regression analysis, which adjusted for age and gender, clinical variables, the number of diseased vessels, renal function, the levels of C-reactive protein, cardiac troponin I, and N-terminal pro-B-type natriuretic peptide, GDF-15 remained an independent predictor of CHD mortality (P < 0.001). Addition of GDF-15 improved the prognostic accuracy of a clinical risk prediction model concerning CHD mortality (c-statistic, 0.84 versus 0.74; P = 0.005). Analysis of the acute coronary syndrome part of the study population confirmed GDF-15 as an independent predictor of CHD mortality (P < 0.001). The circulating levels of GDF-15 did not predict the future risk of nonfatal myocardial infarction in patients with stable angina pectoris or acute coronary syndrome.Conclusion-This study identifies GDF-15 as a strong and independent predictor of CHD mortality across the broad spectrum of patients with stable and unstable CHD. (Circ Cardiovasc Genet. 2009; 2: 286-292.)