Bonaca MP， Morrow DA， Braunwald E， Cannon CP， Jiang S， Breher S， Sabatine MS， Kempf T， Wallentin L， Wollert KC.
    TIMI Study Group， Brigham and Women’s Hospital， Boston， Mass; the Harvard Clinical Research Institute， Boston， Mass; Hannover University Medical School， Hannover， Germany; and Uppsala Clinical Research Center， University Hospital， Uppsala， Sweden.
Abstract
    OBJECTIVE: To investigate growth differentiation factor (GDF)-15 at hospital discharge for assessment of the risk of death， recurrent myocardial infarction (MI)， and congestive heart failure and determination of whether these risks can be modified by statins.
    METHODS AND RESULTS: GDF-15 is a transforming growth factor-β-related cytokine induced in response to tissue injury. GDF-15 concentration is associated with all-cause mortality in patients with acute coronary syndrome (ACS). We measured GDF-15 in 3501 patients after ACS， treated with moderate or intensive statin therapy in PROVE IT-TIMI 22. By using established cut points， GDF-15 (<1200， 1200-1800， and >1800 ng/L) was associated with 2-year risk of death or MI (5.7%， 8.1%， and 15.1%， respectively; P<0.001)， death (P<0.001)， MI (P<0.001)， and congestive heart failure (P<0.001). After adjustment for age， sex， body mass index， diabetes mellitus， hypertension， smoking， MI， qualifying event， renal function， B-type natriuretic peptide， and high-sensitivity C-reactive protein， GDF-15 was associated with the risk of death or MI (adjusted hazard ratio per ln increase GDF-15， 2.1 [95% CI， 1.6 to 2.9]; P<0.001)， death (P<0.001)， MI (P<0.001)， and congestive heart failure (P<0.001). There was no significant interaction between GDF-15 and intensive statin therapy for the risk of death or MI (P=0.24 for the interaction).
    CONCLUSIONS: GDF-15 is associated with recurrent events after ACS， independent of clinical predictors， B-type natriuretic peptide， and high-sensitivity C-reactive protein. This finding supports GDF-15 as a prognostic marker in ACS and investigation of other therapies that modify this risk.