Abstract Introduction Growth differentiation factor-15 (GDF-15) is a member of the transforming growth factor-β superfamily. Its expression was found in various tissues under the circumstances of hypoxia, inflammation, acute injury. GDF-15 is considered as a biomarker of the risk of cardiovascular events, however, most of the studies on GDF-15 have been carried out in patients with chronic heart failure and comorbid pathology. Our study assessed the clinical value of GDF-15 in the acute stage of myocardial infarction (MI) in patients without concomitant inflammatory diseases, cardiac arrhythmias and with an ejection fraction above 40% according to echocardiography. Purpose To evaluate the prognostic value of GDF-15 in patients with acute MI. Materials and methods Our study included 118 patients under the age of 70 years with MI with and without elevation of the ST-segment on the electrocardiogram. We determined the levels of GDF-15 by enzyme-linked immunosorbent assay in the first 48 hours from the clinical onset of MI. The clinical dynamics was assessed by questioning patients at 1, 3, 6 and 12 months after discharge from the hospital. The statistical significance of differences in quantitative indicators was assessed by the Student's t-test for a normal distribution and by the Mann-Whitney U test for a non-normal distribution; in qualitative indicators – according to the Pearson's χ2 criterion. Pearson's and Spearman's correlation coefficients were used to assess the tightness of the relationship between quantitative indicators. Results The average GDF-15 level in patients with acute MI was 2.25±1.0 ng/ml. 29 cardiovascular events occurred during 12 months of observation, including 2 deaths and 8 recurrent MI. According to autopsy data both deaths occurred due to large-focal transmural MI. 22.8% of patients were re-admitted to hospitals for unstable angina pectoris or recurrent MI. Moreover, in 89.6% of that cases GDF-15 was in the third or fourth quartiles and was ≥2.07 ng/ml. Absolutely all patients with recurrent MI and in the case of death had GDF-15 level in the upper quartile (>2.73 ng/ml). Patients with GDF-15 in the upper quartile had a significantly higher risk of recurrent cardiovascular events including cardiovascular mortality and hospitalizations for unstable angina and MI (RR 4.3 [95% CI 2.4–7.9], p<0.05) in comparison with patients with GDF-15 in the three lower quartiles. We assessed the possibility of combined use of GDF-15 and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and it was revealed that patients who simultaneously had GDF-15 and NT-pro-BNP in the upper quartiles (GDF-15 >2.73 ng/ml, NT-proBNP >1418 pg/ml) had a 5.4 times higher risk of recurrent cardiovascular events (RR 5.4 [95% CI 3.4–8.5] p<0.05). Conclusion The increased level of GDF-15 in the acute stage of MI has predictive value and may serve as an additional cardiovascular risk marker. Funding Acknowledgement Type of funding sources: None.