Abstract 12991: Growth Differentiation Factor-15 is a New Predictor of Cardiovascular Events in Atrial Fibrillation Patients After Elective Percutaneous Coronary Intervention

Abstract

Introduction: Patients (pts) with AF, undergoing elective PCI, receiving multicomponent antithrombotic therapy (MAT) have high risk of stroke/systemic embolism and coronary events. There is no biochemical markers associated with negative prognosis in AF pts after elective PCI. Growth differentiation factor-15 (GDF-15) has demonstrated strong relationship with adverse prognosis in pts with cardiovascular disease. Purpose: To investigate the prognostic value of GDF-15 level in AF pts after elective PCI. Methods: 150 pts (104 males), aged 70.8±8.5 years, with AF after elective PCI were enrolled in the prospective study. All pts received DOACs and double (89.3%) or single (10.7%) antiplatelet therapy. Median duration of follow up period was 11.5 months [IQR 8.0; 12.0]. Efficacy endpoint of the study was the sum of cardiovascular events (CVE): ACS, ischemic stroke (IS), VTE, cardiovascular death and need for unplanned PCI. Plasma samples for GDF-15 were analyzed using ELISA. Results: AF pts receiving MAT demonstrated high thrombotic risk (CHA 2 DS 2 -VASc, Med 5 [IQR 4; 6]), high rate of comorbidity (index Charlson, Med 7 [IQR 5; 9]). Frequency of CVE during follow up period was 16% (ACS 2; fatal IS 2; VTE 2, include 1 fatal pulmonary embolism; cardiovascular death 2; pts needed an unplanned PCI 16). Median GDF-15 level was 1270 pg/ml [IQR 953; 1778]. According to multiple regression analysis GDF-15 level was associated with the D-dimer (t=3.20; p=0.0018), diabetes mellitus (t=3.97; p=0.0001) and clinical and angiographic Syntax II score (t=4.77; p<0.0001). In pts with only coronary artery disease, the level of GDF-15 was significantly lower than in pts with atherosclerotic lesion of 3 vascular pools (p=0,0119). According to ROC analysis GDF-15 level > 1191 pg / ml (sensitivity 83.0, specifity 50.0) increase the probability of the development of CVE (AUC=0.647, p=0.0076, 95% CI 0.565–0.723). Kaplan-Meier curves demonstrated significant difference in CVE free survival between the patients with GDF-15 level > and ≤ 1191 pg/ml (75.9% and 94.0% respectively, log-rank test p = 0.0032, [HR 4.36, CI 1.50-7.48]). Conclusions: GDF-15 is a possible marker of CVE determining prognosis in AF pts after elective PCI. The results could be used to individualize the duration of MAT.