Growth differentiation factor 15: A biomarker to guide empagliflozin treatment in acute myocardial infarction?

Abstract

Introduction: Growth Differentiation Factor-15 (GDF-15) has been proven useful as a prognostic biomarker after an acute myocardial infarction (MI) and might be used to refine the selection of high-risk patients that could benefit from empagliflozin therapy. This study aims to compare the prognostic performance of GDF-15 with the inclusion criteria of the EMPACT-MI trial to identify patients at high risk of developing heart failure (HF) after an acute MI.

Methods and results: A cohort of 275 acute MI patients with GDF-15 concentration available and long-term follow-up was analyzed. Patients were classified into two categories, high risk (HRHF) or no high risk of development of HF (NHRHF), according to two models: 1) GDF-15: HRHF if >1800 ng/L and NHRHF if ≤1800 ng/L; and 2) EMPACT-MI criteria: HRHF if meeting the trial inclusion criteria. Cox regression and ROC curve analyses were used to evaluate the prognostic performance of both models. GDF-15 showed a stronger association with the composite endpoint of all-cause death or first hospitalization for HF (HR 10.7, 95 % CI 5.5-21.0) compared to EMPACT-MI inclusion criteria (HR 3.9, 95 % CI 2.2-6.8). Additionally, GDF-15 had superior discriminative ability (c-index 0.790 vs 0.629, p = 0.004). Similar results were obtained for HF first hospitalization.

Conclusions: GDF-15 may have a better discriminative ability than the inclusion criteria of the EMPACT-MI trial to identify those patients at higher risk of death and HF after an acute MI, who could potentially benefit from empagliflozin therapy.

Keywords: Acute myocardial infarction; Empagliflozin; GDF-15; Heart failure.