Growth differentiation factor-15 predicts all- cause death and major adverse cardiovascular events in patients with coronary heart disease: a prospective cohort study

被引:1
作者
Lyu, Lyu [1 ,2 ]
Xv, Cui [3 ]
Xu, Juan [4 ]
Liu, Zhenzhen [5 ]
He, Yanru [5 ]
Zhu, Wenjing [5 ]
Lin, Lin [5 ]
Yang, Qiang [5 ]
Wei, Yun [5 ]
Wang, Jinda [6 ]
Huang, Taoke [1 ,2 ]
Hao, Benchuan [1 ,2 ]
Liu, Hongbin [1 ,7 ]
机构
[1] Chinese Peoples Liberat Army Gen Hosp, Dept Cardiol, Med Ctr 2, Beijing, Peoples R China
[2] Chinese PLA, Med Sch, Beijing, Peoples R China
[3] 305 Hosp PLA, Dept Med Adm, Beijing, Peoples R China
[4] Hangzhou Normal Univ, Affiliated Xiaoshan Hosp, Dept Gen Surg, Hangzhou, Peoples R China
[5] Xi An Jiao Tong Univ, Dept Cardiol, Affiliated Hosp 2, Xian, Peoples R China
[6] Chinese Peoples Liberat Army Gen Hosp, Dept Cardiol, Med Ctr 6, Beijing, Peoples R China
[7] Beijing Key Lab Chron Heart Failure Precis Med, Beijing, Peoples R China
关键词
Growth differentiation factor-15; Coronary heart disease; Major adverse cardiovascular events; All-cause mortalit; Framingham risk score; MYOCARDIAL-INFARCTION; RISK STRATIFICATION; EUROPEAN-SOCIETY; MORTALITY; MARKER; ASSOCIATION; DYSFUNCTION; BIOMARKERS; STRESS; MEMBER;
D O I
10.1007/s11239-024-03019-5
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The prognostic value of growth differentiation factor-15 (GDF-15) in predicting long-term adverse outcomes in coronary heart disease (CHD) patients remains limited. Our study examines the association between GDF-15 and adverse outcomes over an extended period in CHD patients and firstly assesses the incremental prognostic effect of incorporating GDF-15 into the Framingham risk score (FRS)-based model. This single-center prospective cohort study included 3,321 patients with CHD categorized into 2,479 acute coronary syndrome (ACS) (74.6%) and 842 non-ACS (25.4%) groups. The median age was 61.0 years (range: 53.0-70.0), and 917 (27.6%) were females. Mortality and major adverse cardiovascular events (MACEs) included cardiovascular mortality, myocardial infarction (MI), stroke, and heart failure (HF) (inclusive of HF episodes requiring outpatient treatment and/or hospital admission). Cox regression models assessed the associations between GDF-15 and the incidence of all-cause mortality and MACEs. Patients were stratified into three groups based on GDF-15 levels: the first tertile group (< 1,370 ng/L), the second tertile group (1,370-2,556 ng/L), and the third tertile group (> 2,556 ng/L). The C-index, integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA) were used to assess incremental value. Over a median 9.4-year follow-up, 759 patients (22.9%) died, and 1,291 (38.9%) experienced MACEs. The multivariate Cox model indicated that GDF-15 was significantly associated with all-cause mortality (per ln unit increase, HR = 1.49, 95% CI: 1.36-1.64) and MACEs (per ln unit increase, HR = 1.29, 95% CI: 1.20-1.38). These associations persisted when GDF-15 was analyzed as an ordinal variable (p for trend < 0.05). Subgroup analysis of ACS and non-ACS for the components of MACEs separately showed a significant association between GDF-15 and both cardiovascular mortality and HF, but no association was observed between GDF-15 and MI /stroke in both ACS and non-ACS patients. The addition of GDF-15 to the FRS-based model enhanced the discrimination for both all-cause mortality (Delta C-index = 0.009, 95% CI: 0.005-0.014; IDI = 0.030, 95% CI: 0.015-0.047; continuous NRI = 0.631, 95% CI: 0.569-0.652) and MACEs (. C-index = 0.009, 95% CI: 0.006-0.012; IDI = 0.026, 95% CI: 0.009-0.042; continuous NRI = 0.593, 95% CI: 0.478-0.682). DCA suggested that incorporating GDF-15 into the FRS-based model demonstrated higher net benefits compared to FRS-based models alone (All-cause mortality: FRS-based model: area under the curve of DCA (AUDC) = 0.0903, FRS-based model + GDF-15: AUDC = 0.0908; MACEs: FRS-based model: AUDC = 0.1806, FRS-based model + GDF-15: AUDC = 0.1833). GDF-15 significantly associates with the long-term prognosis of all-cause mortality and MACEs in CHD patients and significantly improves the prognostic accuracy of the FRS-based model for both outcomes.
引用
收藏
页码:1109 / 1121
页数:13
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