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Licensed Unlicensed Requires Authentication Published by De Gruyter February 1, 2019

Acute-phase dynamics and prognostic value of growth differentiation factor-15 in ST-elevation myocardial infarction

Ferran Rueda, Josep Lupón, Cosme García-García, German Cediel, M. Cruz Aranda Nevado, Judith Serra Gregori, Carlos Labata, Teresa Oliveras, Marc Ferrer, Oriol de Diego, Jordi Serra, Elena Revuelta López and Antoni Bayés-Genís



Growth differentiation factor 15 (GDF-15) in ST-elevation myocardial infarction (STEMI) is prognostic in first-generation radioimmunoassays. We examined GDF-15 temporal dynamics in STEMI and its predictive value using a first fully automated GDF-15 electrochemiluminescence assay.


In this prospective study, circulating GDF-15 concentration was measured at admission (0 h), 12 h and 24 h in 1026 consecutive STEMI patients treated between February 2011 and May 2016 with primary percutaneous coronary intervention. GDF-15 dynamics (0 h, 12 h, 24 h) and predictive value (30 days and 3 years) were examined.


Median GDF-15 concentration was 1443 pg/mL at 0 h, 1731 pg/mL at 12 h and 1510 pg/mL at 24 h (p<0.001). During follow-up, 94 patients died (9.2%) and 154 (15.0%) were hospitalized. GDF-15 was a strong predictor of 30-day mortality (hazard ratio [HR] 1.76, 95% confidence interval [CI], 1.33–2.34 at 0 h; HR 2.99 [95% CI, 2.18–4.09] at 12 h, and HR 1.97 [95% CI, 1.47–2.63] at 24 h) in multivariable Cox proportional hazards models. GDF-15 improved discrimination and reclassification of a clinical risk model. GDF-15 was also associated with 3-year mortality (HR 1.31 [95% CI, 1.04–1.65] at 0 h, HR 1.42 [95% CI, 1.10–1.84] at 12 h, and HR 1.51 [95% CI, 1.16–1.96] at 24 h) and 3-year composite of mortality and cardiovascular hospitalization (HR 1.17 [95% CI, 1.01–1.37] at 0 h, HR 1.20 [95% CI, 1.02–1.42] at 12 h, and HR 1.27 [95% CI, 1.08–1.50] at 24 h).


GDF-15 peaked at 12 h and remained elevated at 24 h in STEMI. GDF-15 measurement during the first 24 h in STEMI is valuable for predicting especially short- but also long-term outcomes, and may be a useful addition to risk stratification.

Corresponding author: Antoni Bayés-Genís, MD, PhD, FESC, Head, Heart Institute, Germans Trias i Pujol University Hospital, Carretera de Canyet s/n 08916, Badalona (Barcelona), Spain; and Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
aPhD Program in Internal Medicine, Autonomous University of Barcelona, Barcelona, Spain

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: Roche Diagnostics supported this research by running the GDF-15, hs-TnT and NT-proBNP assays free of charge. However, the authors are solely responsible for the design and conduct of the study, all analyses and the drafting and editing of the manuscript.

  3. Employment or leadership: None declared.

  4. Honorarium: AB-G and JL received honoraria for lectures and advisory boards from Roche Diagnostics.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.


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Supplementary Material

The online version of this article offers supplementary material (

Received: 2018-11-05
Accepted: 2018-12-28
Published Online: 2019-02-01
Published in Print: 2019-06-26

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