{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T10:22:52Z","timestamp":1772706172085,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T00:00:00Z","timestamp":1590364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Growth Differentiation Factor-15 (GDF-15) is a strong predictor of decreased myocardial salvage and subsequent higher risk of death in patients with STEMI, but no information has been published regarding the association of GDF-15 levels with coronary blood flow in STEMI. We hypothesized that elevated GDF-15 levels would be associated with impaired flow and perfusion in the setting of STEMI treated with primary PCI. Eighty consecutive patients who were admitted with STEMI within 6 h from symptom onset were enrolled in the study. Patients were divided into two groups based upon the Thrombolysis in Myocardial Infarction (TIMI) flow grade. Group 1 was defined as TIMI Grade 0, 1 and 2 flows. Angiographic success was defined as TIMI 3 flow (group 2). GDF-15 and high sensitive CRP were measured. Major adverse cardiac events (MACE) were defined as stent thrombosis, nonfatal myocardial infarction and in-hospital mortality. There were 35 patients (mean age 64 \u00b1 11.8 and 20% female) in group 1 and 45 patients (mean age 66.8 \u00b1 11.5 and 29% female) in group 2. GDF-15 and hs-CRP levels were significantly higher in group 1 than in group 2 (1670 \u00b1 831pg\/mL vs. 733 \u00b1 124 pg\/mL, p &lt; 0.001; and 19.8 \u00b1 10.6 vs. 11.3 \u00b1 4.9, p &lt; 0.001). GDF-15 level \u2265920 pg\/mL measured on admission had a 94% sensitivity and 91% specificity in predicting no-reflow at ROC curve analysis. In-hospital MACE was also significantly higher in group 1 (28.6% vs. 2.2%, p: 0.001). Additionally, there was a significant correlation between hs-CRP and GDF-15 (r: 0.6030.56; p &lt; 0.001). The GDF-15 level on admission is a strong and independent predictor of poor coronary blood flow following primary PCI and in hospital MACE among patients with STEMI. Except for predictive value, GDF-15 levels may be a useful biomarker for the stratification of risk in patients with STEMI, and may carry further therapeutic implications.<\/jats:p>","DOI":"10.3390\/diseases8020016","type":"journal-article","created":{"date-parts":[[2020,5,25]],"date-time":"2020-05-25T11:42:02Z","timestamp":1590406922000},"page":"16","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Assessment of Growth Differentiation Factor 15 Levels on Coronary Flow in Patients with STEMI Undergoing Primary PCI"],"prefix":"10.3390","volume":"8","author":[{"given":"Orhan","family":"Dogdu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Medical Park Hospital, Elazig 23000, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.ijcard.2006.05.012","article-title":"Baseline systemic inflammatory status and no-reflow phenomenon after percutaneous coronary angioplasty for acute myocardial infarction","volume":"117","author":"Niccoli","year":"2007","journal-title":"Int. J. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"GUSTO Angiographic Investigators (1993). The effects of tissue plasminogen activator, streptokinase, or both on coronary-artery patency, ventricular function, and survival after acute myocardial infarction. NEjM, 329, 1615\u20131622.","DOI":"10.1056\/NEJM199311253292204"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1536\/ihj.16-448","article-title":"Impact of Postprocedural TIMI Flow on Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction","volume":"58","author":"Kim","year":"2017","journal-title":"Int. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1161\/01.CIR.93.2.223","article-title":"Clinical implications of the \u2019no reflow\u2019 phenomenon. A predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction","volume":"93","author":"Ito","year":"1996","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1016\/j.jacc.2005.03.065","article-title":"Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention","volume":"46","author":"Huczek","year":"2005","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"117","DOI":"10.3109\/09537100903487599","article-title":"Mean platelet volume on admission correlates with impaired response to thrombolysis in patients with ST-elevation myocardial infarction","volume":"21","author":"Pereg","year":"2010","journal-title":"Platelets"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1002\/clc.4960270314","article-title":"The relation between preprocedural C-reactive protein levels and early and late complications in patients with acute myocardial infarction undergoing interventional coronary angioplasty","volume":"27","author":"Magadle","year":"2004","journal-title":"Clin. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1067\/mhj.2000.108244","article-title":"Prognostic value of C-reactive protein levels within six hours after the onset of acute myocardial infarction","volume":"140","author":"Tomoda","year":"2000","journal-title":"Am. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jjcc.2009.03.003","article-title":"Predictors of no-reflow after percutaneous coronary intervention for culprit lesion with plaque rupture in infarct-related artery in patients with acute myocardial infarction","volume":"54","author":"Hong","year":"2009","journal-title":"J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11514","DOI":"10.1073\/pnas.94.21.11514","article-title":"MIC-1, a novel macrophage inhibitory cytokine, is a divergent member of the TGF-\u03b2 superfamily","volume":"94","author":"Bootcov","year":"1997","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"946","DOI":"10.5966\/sctm.2013-0055","article-title":"Concise Review: Growth Differentiation Factor 15 in Pathology: A Clinical Role?","volume":"2","author":"Corre","year":"2013","journal-title":"STEM CELLS Transl. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1536\/ihj.15-324","article-title":"Growth Differentiation Factor 15 (GDF15) as a Reliable Biomarker for Cardiovascular Risk Assessment","volume":"57","author":"Ikeda","year":"2016","journal-title":"Int. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1540","DOI":"10.1161\/CIRCULATIONAHA.107.697714","article-title":"Growth Differentiation Factor 15 for Risk Stratification and Selection of an Invasive Treatment Strategy in Non\u2013ST-Elevation Acute Coronary Syndrome","volume":"116","author":"Wollert","year":"2007","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1161\/CIRCGENETICS.109.877456","article-title":"Growth-Differentiation Factor-15 for Long-Term Risk Prediction in Patients Stabilized After an Episode of Non\u2013ST-Segment\u2013Elevation Acute Coronary Syndrome","volume":"3","author":"Eggers","year":"2010","journal-title":"Circ. Cardiovasc. Genet."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1136\/hrt.2010.219543","article-title":"Growth-differentiation factor 15 as predictor of mortality in acute reperfused ST-elevation myocardial infarction: Insights from cardiovascular magnetic resonance","volume":"97","author":"Eitel","year":"2011","journal-title":"Heart"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"(1985). The TIMI Study Group* The Thrombolysis in Myocardial Infarction (TIMI) Trial. N. Engl. J. Med., 312, 932\u2013936.","DOI":"10.1056\/NEJM198504043121437"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3109\/17482941.2010.498919","article-title":"Prevention and treatment of no-reflow","volume":"12","author":"Niccoli","year":"2010","journal-title":"Acute Card. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1161\/hc0502.102867","article-title":"No-reflow phenomenon","volume":"105","author":"Rezkalla","year":"2002","journal-title":"Circulation"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2159","DOI":"10.1016\/S0140-6736(02)09093-1","article-title":"Concentration in plasma of macrophage inhibitory cytokine-1 and risk of cardiovascular events in women: A nested case-control study","volume":"359","author":"Breit","year":"2002","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1093\/eurheartj\/ehp261","article-title":"Growth-differentiation factor-15 is an independent marker of cardiovascular dysfunction and disease in the elderly: Results from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) Study","volume":"30","author":"Lind","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1002\/ejhf.431","article-title":"Growth differentiation factor 15 in heart failure with preserved vs. reduced ejection fraction","volume":"18","author":"Chan","year":"2015","journal-title":"Eur. J. Heart Fail."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2858","DOI":"10.1093\/eurheartj\/ehm465","article-title":"Growth-differentiation factor-15 improves risk stratification in ST-segment elevation myocardial infarction","volume":"28","author":"Kempf","year":"2007","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.ahj.2015.02.019","article-title":"Biomarkers for risk stratification of patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention: Insights from the Platelet Inhibition and Patient Outcomes trial","volume":"169","author":"Velders","year":"2015","journal-title":"Am. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s00441-004-0986-3","article-title":"Involvement of growth differentiation factor-15\/macrophage inhibitory cytokine-1 (GDF-15\/MIC-1) in oxLDL-induced apoptosis of human macrophages in vitro and in arteriosclerotic lesions","volume":"318","author":"Schlittenhardt","year":"2004","journal-title":"Cell Tissue Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1097\/MAJ.0b013e318291cd4e","article-title":"Growth-Differentiation Factor-15 and Major Cardiac Events","volume":"347","author":"Lin","year":"2014","journal-title":"Am. J. Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1161\/01.RES.0000207919.83894.9d","article-title":"GDF15, a cardioprotective TGF-beta superfamily protein","volume":"98","author":"Ago","year":"2006","journal-title":"Circ. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1093\/eurheartj\/ehr444","article-title":"Adjustment of the GRACE score by growth differentiation factor 15 enables a more accurate appreciation of risk in non-ST-elevation acute coronary syndrome","volume":"33","author":"Widera","year":"2011","journal-title":"Eur. Heart J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1161\/01.RES.0000202805.73038.48","article-title":"The Transforming Growth Factor-\u03b2 Superfamily Member Growth-Differentiation Factor-15 Protects the Heart From Ischemia\/Reperfusion Injury","volume":"98","author":"Kempf","year":"2006","journal-title":"Circ. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1038\/nm.2354","article-title":"GDF-15 is an inhibitor of leukocyte integrin activation required for survival after myocardial infarction in mice","volume":"17","author":"Kempf","year":"2011","journal-title":"Nat. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1093\/eurheartj\/ehq077","article-title":"Growth differentiation factor-15 and cardiovascular dysfunction and disease: Malefactor or innocent bystander?","volume":"31","author":"Taddei","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/j.amjcard.2011.05.028","article-title":"Relation of Growth-Differentiation Factor 15 to Left Ventricular Remodeling in ST-Segment Elevation Myocardial Infarction","volume":"108","author":"Avanzas","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1093\/eurheartj\/ehn600","article-title":"Growth differentiation factor-15 as a prognostic marker in patients with acute myocardial infarction","volume":"30","author":"Khan","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.amjcard.2010.03.018","article-title":"Relation of Baseline High-Sensitivity C-Reactive Protein Level to Cardiovascular Outcomes With Rosuvastatin in the Justification for Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER)","volume":"106","author":"Ridker","year":"2010","journal-title":"Am. J. Cardiol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/8\/2\/16\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:32:18Z","timestamp":1760175138000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/8\/2\/16"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,25]]},"references-count":33,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["diseases8020016"],"URL":"https:\/\/doi.org\/10.3390\/diseases8020016","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,25]]}}}