scholarly journals Biomarkers and Coronary Lesions Predict Outcomes after Revascularization in Non–ST-Elevation Acute Coronary Syndrome

2017 ◽  
Vol 63 (2) ◽  
pp. 573-584 ◽  
Author(s):  
Daniel Lindholm ◽  
Stefan K James ◽  
Maria Bertilsson ◽  
Richard C Becker ◽  
Christopher P Cannon ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Troponin T ◽  
Full Model ◽  
Standard Deviation Increase ◽  
Clinical Variables ◽  
Coronary Syndrome ◽  
End Point ◽  
C Statistic ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

Abstract BACKGROUND Risk stratification in non–ST-elevation acute coronary syndrome (NSTE-ACS) is currently mainly based on clinical characteristics. With routine invasive management, angiography findings and biomarkers are available and may improve prognostication. We aimed to assess if adding biomarkers [high-sensitivity cardiac troponin T (cTnT-hs), N-terminal probrain-type natriuretic peptide (NT-proBNP), growth differentiation factor 15 (GDF-15)] and extent of coronary artery disease (CAD) might improve prognostication in revascularized patients with NSTE-ACS. METHODS In the PLATO (Platelet Inhibition and Patient Outcomes) trial, 5174 NSTE-ACS patients underwent initial angiography and revascularization and had cTnT-hs, NT-proBNP, and GDF-15 measured. Cox models were developed adding extent of CAD and biomarker levels to established clinical risk variables for the composite of cardiovascular death (CVD)/spontaneous myocardial infarction (MI), and CVD alone. Models were compared using c-statistic and net reclassification improvement (NRI). RESULTS For the composite end point and CVD, prognostication improved when adding extent of CAD, NT-proBNP, and GDF-15 to clinical variables (c-statistic 0.685 and 0.805, respectively, for full model vs 0.649 and 0.760 for clinical model). cTnT-hs did not contribute to prognostication. In the full model (clinical variables, extent of CAD, all biomarkers), hazard ratios (95% CI) per standard deviation increase were for cTnT-hs 0.93(0.81–1.05), NT-proBNP 1.32(1.13–1.53), GDF-15 1.20(1.07–1.36) for the composite end point, driven by prediction of CVD by NT-proBNP and GDF-15. For spontaneous MI, there was an association with NT-proBNP or GDF-15, but not with cTnT-hs. CONCLUSIONS In revascularized patients with NSTE-ACS, the extent of CAD and concentrations of NT-proBNP and GDF-15 independently improve prognostication of CVD/spontaneous MI and CVD alone. This information may be useful for selection of patients who might benefit from more intense and/or prolonged antithrombotic treatment. ClinicalTrials.gov Identifier: NCT00391872

scholarly journals Growth Differentiation Factor 15 for Risk Stratification and Selection of an Invasive Treatment Strategy in Non–ST-Elevation Acute Coronary Syndrome

Circulation ◽  
2007 ◽  
Vol 116 (14) ◽  
pp. 1540-1548 ◽  
Author(s):  
Kai C. Wollert ◽  
Tibor Kempf ◽  
Bo Lagerqvist ◽  
Bertil Lindahl ◽  
Sylvia Olofsson ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Confidence Interval ◽  
Risk Stratification ◽  
Treatment Strategy ◽  
Hazard Ratio ◽  
Invasive Treatment ◽  
Coronary Syndrome ◽  
End Point ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

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 II (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 <1200 ng/L (hazard ratio, 1.06; 95% confidence interval, 0.68 to 1.65; P =0.81). Patients with ST-segment depression or a troponin T level >0.01 μg/L with a GDF-15 level <1200 ng/L did not benefit from the invasive strategy. Conclusions— GDF-15 is a potential tool for risk stratification and therapeutic decision making in patients with non–ST-elevation acute coronary syndrome as initially diagnosed by ECG and troponin levels. A prospective randomized trial is needed to validate these findings.

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