Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Growth differentiation factor-15 improves long-term mortality risk prediction beyond the GRACE 2.0 score after acute coronary syndrome

Lenell, Joel ; Lindahl, Bertil ; Erlinge, David LU orcid ; Jernberg, Tomas ; Spaak, Jonas and Baron, Tomasz (2026) In Scientific Reports 16(1).
Abstract

This study examined whether Growth Differentiation Factor-15 (GDF-15) and echocardiographic measures of systolic left ventricular function improve intermediate- and long-term mortality risk prediction beyond the guideline-endorsed GRACE 2.0 score after Acute Coronary Syndrome (ACS). 751 ACS patients were included. GDF-15, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) were added stepwise to GRACE 2.0 in Cox regression models. Discriminative performance was assessed using the C-index for all-cause mortality at 3 years and long-term up to a median follow-up of 6.4 years. Mean age was 64.4 years, and 77% were men. There were 40 deaths at 3 years and 104 deaths by end-of-study. GDF-15 outperformed GRACE 2.0... (More)

This study examined whether Growth Differentiation Factor-15 (GDF-15) and echocardiographic measures of systolic left ventricular function improve intermediate- and long-term mortality risk prediction beyond the guideline-endorsed GRACE 2.0 score after Acute Coronary Syndrome (ACS). 751 ACS patients were included. GDF-15, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) were added stepwise to GRACE 2.0 in Cox regression models. Discriminative performance was assessed using the C-index for all-cause mortality at 3 years and long-term up to a median follow-up of 6.4 years. Mean age was 64.4 years, and 77% were men. There were 40 deaths at 3 years and 104 deaths by end-of-study. GDF-15 outperformed GRACE 2.0 for 3-year mortality prediction (time-dependent AUC 0.82 [95% CI 0.75–0.89] vs. 0.76 [95% CI 0.67–0.84]; P = 0.001). Adding GDF-15 to GRACE 2.0 improved long-term prognostic accuracy, increasing the C-index from 0.74 (95% CI 0.69–0.79) to 0.76 (95% CI 0.70–0.81). LVEF and GLS improved the C-index in the order of 0.01 when added to GRACE 2.0. GDF-15 meaningfully improved discrimination of all-cause death, both at intermediate- and long-term follow-up, when added on top of GRACE 2.0 whereas LVEF and GLS both provided minor improvements.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute coronary syndrome, Ejection fraction, Mortality, Myocardial infarction, Outcome, Strain
in
Scientific Reports
volume
16
issue
1
article number
5241
publisher
Nature Publishing Group
external identifiers
  • scopus:105029577927
  • pmid:41644662
ISSN
2045-2322
DOI
10.1038/s41598-026-38905-w
language
English
LU publication?
yes
id
6ead8420-3081-4d11-9892-1f0da6710cfb
date added to LUP
2026-02-27 14:43:49
date last changed
2026-02-27 14:44:33
@article{6ead8420-3081-4d11-9892-1f0da6710cfb,
  abstract     = {{<p>This study examined whether Growth Differentiation Factor-15 (GDF-15) and echocardiographic measures of systolic left ventricular function improve intermediate- and long-term mortality risk prediction beyond the guideline-endorsed GRACE 2.0 score after Acute Coronary Syndrome (ACS). 751 ACS patients were included. GDF-15, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) were added stepwise to GRACE 2.0 in Cox regression models. Discriminative performance was assessed using the C-index for all-cause mortality at 3 years and long-term up to a median follow-up of 6.4 years. Mean age was 64.4 years, and 77% were men. There were 40 deaths at 3 years and 104 deaths by end-of-study. GDF-15 outperformed GRACE 2.0 for 3-year mortality prediction (time-dependent AUC 0.82 [95% CI 0.75–0.89] vs. 0.76 [95% CI 0.67–0.84]; P = 0.001). Adding GDF-15 to GRACE 2.0 improved long-term prognostic accuracy, increasing the C-index from 0.74 (95% CI 0.69–0.79) to 0.76 (95% CI 0.70–0.81). LVEF and GLS improved the C-index in the order of 0.01 when added to GRACE 2.0. GDF-15 meaningfully improved discrimination of all-cause death, both at intermediate- and long-term follow-up, when added on top of GRACE 2.0 whereas LVEF and GLS both provided minor improvements.</p>}},
  author       = {{Lenell, Joel and Lindahl, Bertil and Erlinge, David and Jernberg, Tomas and Spaak, Jonas and Baron, Tomasz}},
  issn         = {{2045-2322}},
  keywords     = {{Acute coronary syndrome; Ejection fraction; Mortality; Myocardial infarction; Outcome; Strain}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{Nature Publishing Group}},
  series       = {{Scientific Reports}},
  title        = {{Growth differentiation factor-15 improves long-term mortality risk prediction beyond the GRACE 2.0 score after acute coronary syndrome}},
  url          = {{http://dx.doi.org/10.1038/s41598-026-38905-w}},
  doi          = {{10.1038/s41598-026-38905-w}},
  volume       = {{16}},
  year         = {{2026}},
}