Growth differentiation factor 15 for risk stratification and selection of an invasive treatment strategy in non-ST-elevation acute coronary syndrome
Growth differentiation factor 15 for risk stratification and selection of an invasive treatment strategy in non-ST-elevation acute coronary syndrome
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DOI：
10.1161/circulationaha.107.697714
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发表时间：
2007-10-02
期刊：
影响因子：
37.8
通讯作者：
Wallentin, Lars
中科院分区：
文献类型：
--
作者：
Wollert, Kai C.;Kempf, Tibor;Wallentin, Lars
背景-侵入性治疗策略可改善中高危非ST段抬高急性冠状动脉综合征患者的预后。我们假设，生长分化因子15（GDF-15）的循环水平可能会改善risk stabilization.Methods和结果-快速血运重建在不稳定的冠状动脉疾病11（FRISC-II）试验随机患者与非ST段抬高急性冠状动脉综合征的侵入性或保守性策略，随访2年。GDF-15和其他生物标志物在2079例患者入院时进行了测定。770例患者（37.0%）GDF-15中度升高（1200 - 1800 ng/L），493例患者（23.7%）高度升高（> 1800 ng/L）。GDF-15水平升高可独立预测保守组中死亡或复发性心肌梗死复合终点的风险（P=0.016），但在侵袭性组中则不然。入院时GDF-15水平与治疗策略对复合终点的影响之间存在显著的相互作用。当GDF-15水平>1800 ng/L时，侵入性策略可降低复合终点的发生率（风险比，0.49; 95%置信区间，0.33 - 0.73; P=0.001），1200 - 1800 ng/L（风险比，0.68; 95%置信区间，0.46至1.00; P=0.048），但在GDF-15水平下，
Background - An invasive treatment strategy improves outcome in patients with non-ST-elevation acute coronary syndrome at moderate to high risk. We hypothesized that the circulating level of growth differentiation factor 15 (GDF-15) may improve risk stratification.Methods and Results - The Fast Revascularization during InStability in Coronary artery disease 11 (FRISC-II) trial randomized patients with non-ST-elevation acute coronary syndrome to an invasive or conservative strategy with a follow-up for 2 years. GDF-15 and other biomarkers were determined on admission in 2079 patients. GDF-15 was moderately elevated (between 1200 and 1800 ng/L) in 770 patients (37.0%), and highly elevated (> 1800 ng/L) in 493 patients (23.7%). Elevated levels of GDF-15 independently predicted the risk of the composite end point of death or recurrent myocardial infarction in the conservative group (P=0.016) but not in the invasive group. A significant interaction existed between the GDF-15 level on admission and the effect of treatment strategy on the composite end point. The occurrence of the composite end point was reduced by the invasive strategy at GDF-15 levels >1800 ng/L (hazard ratio, 0.49; 95% confidence interval, 0.33 to 0.73; P=0.001), between 1200 and 1800 ng/L (hazard ratio, 0.68; 95% confidence interval, 0.46 to 1.00; P=0.048), but not 0.01 mu g/L with a GDF-15 level