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Limited incremental value of growth differentiation factor 15 in the initial evaluation of low and intermediate risk acute chest pain patients

Karaji, I; Steiro, O-T; Myrmel, GMS; Omland, T; Tjora, HL; Langørgen, J; Bjørneklett, R; Skadberg, Ø; Bonarjee, VVS; Mjelva, ØR; et al. Karaji, I; Steiro, O-T; Myrmel, GMS; Omland, T; Tjora, HL; Langørgen, J; Bjørneklett, R; Skadberg, Ø; Bonarjee, VVS; Mjelva, ØR; Collinson, P; Vikenes, K; Larsen, TH; Aakre, KM; Pedersen, ER (2025) Limited incremental value of growth differentiation factor 15 in the initial evaluation of low and intermediate risk acute chest pain patients. CLINICAL BIOCHEMISTRY, 137. p. 110926. ISSN 0009-9120 https://doi.org/10.1016/j.clinbiochem.2025.110926
SGUL Authors: Collinson, Paul

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Abstract

Introduction Expression of the cytokine growth differentiation factor 15 (GDF-15) is up-regulated in conditions of tissue injury and stress. We evaluated if GDF-15 predicts obstructive coronary artery disease (CAD) or need for revascularization within 30 days and 12 months in low/intermediate risk patients with acute chest pain. Materials and Methods We included 537 hospitalized patients who had high-sensitivity troponin T (hs-cTnT) < 99th percentile and underwent coronary CT angiography (CCTA). Odds ratios (ORs) and 95 % confidence intervals (CI) were calculated by logistic regression analyses and are reported per standard deviation increment of GDF-15 (log-transformed). Results The median (25th-75th percentile) age was 56 (49–65) years, 217 (40.4 %) were women, 83 (15.5 %) had obstructive CAD at CCTA. In total 49 (9.1 %) patients underwent revascularization within 30 days and 52 (9.7 %) within 12 months. In age and sex adjusted analysis GDF-15 was a significant predictor with ORs (95 % CI) of 1.35 (1.05–1.73), 1.39 (1.06–1.83) and 1.41 (1.07–1.84) for obstructive CAD, revascularization within 30 days and 12 months, respectively. However, after adjustment for clinical covariables, the ORs of GDF-15 were no longer statistically significant for either outcome (P ≥ 0.07). Adding hs-cTnT levels alone to the age and sex adjusted model also rendered the ORs of GDF-15 non-significant (P ≥ 0.31). Conclusions In patients with acute chest pain but without acute myocardial infarction, GDF-15 did not substantially improve the identification of obstructive CAD or need for revascularization within 30 days and 12 months. Our findings question the clinical usefulness of GDF-15 for prognostication of low-risk patients with acute chest pain.

Item Type: Article
Additional Information: © 2025 The Authors. Published by Elsevier Inc. on behalf of The Canadian Society of Clinical Chemists. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Biomarkers, Acute chest pain, GDF-15, High-sensitivity troponin, Rule-in/Rule-out algorithm, CCTA, Prognostication
SGUL Research Institute / Research Centre: Academic Structure > Cardiovascular & Genomics Research Institute
Academic Structure > Cardiovascular & Genomics Research Institute > Clinical Cardiology
Journal or Publication Title: CLINICAL BIOCHEMISTRY
ISSN: 0009-9120
Language: en
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
F-12164/4800003682Western Norway Regional Health AuthorityUNSPECIFIED
F-12589Western Norway Regional Health AuthorityUNSPECIFIED
UNSPECIFIEDRoche Diagnosticshttps://doi.org/10.13039/100016545
URI: https://openaccess.sgul.ac.uk/id/eprint/117547
Publisher's version: https://doi.org/10.1016/j.clinbiochem.2025.110926

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