Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables?

Growth Differentiation Factor 15 as a Predictor of the No-Reflow Phenomenon in Patients with ST-Segment Elevation Myocardial Infarction

Growth differentiation factor 15 (GDF-15) and the no-reflow phenomenon are predictors of mortality after ST-segment elevation myocardial infarction (STEMI). We aimed to assess the relation between GDF-15 concentration on admission and the no-reflow phenomenon. The study was conducted prospectively among 80 consecutive STEMI patients who underwent primary PCI. No-reflow was defined as a corrected TIMI frame count > 27 and myocardial blush grade < 3 after PCI. GDF-15 was measured on admission. We assessed long-term (1.3 years) total mortality and the risk factors of no-reflow. The mean age was 65 (SD 12) years. Mortality rates were 2.5% and 7.5% for in-hospital and long-term observations, respectively. No-reflow occurred in 24% of patients. A negative correlation between TIMI flow after PCI and GDF-15 concentration (R = −0.2540, p = 0.023) was found. Receiver operating characteristic (ROC) analysis revealed GDF-15 as a predictor of no-reflow (AUC-0.698, 95%CI-0.552−0.843, p < 0.05). The multivariate logistic regression analysis revealed that the risk factors for no-reflow occurrence were higher age, a concentration of GDF-15 > 1503 pg/mL, lower systolic blood pressure, and higher troponin I concentration on admission. A higher concentration of GDF-15 can be used as an additional marker of ischemia/reoxygenation injury, subsequent no-reflow phenomenon, and worse long-term outcomes in patients with STEMI.