{"id":624,"date":"2019-02-07T18:53:45","date_gmt":"2019-02-07T18:53:45","guid":{"rendered":"http:\/\/clinicalbiochemistry.net\/?page_id=624"},"modified":"2019-02-07T18:53:45","modified_gmt":"2019-02-07T18:53:45","slug":"p-selectin-in-ami","status":"publish","type":"page","link":"http:\/\/clinicalbiochemistry.net\/?page_id=624","title":{"rendered":"P-Selectin in AMI"},"content":{"rendered":"\n

Body, R., Pemberton, P., Ali, F., McDowell, G.<\/strong>, Carley, S., Smith, A. & Mackway-Jones, K. (2011) \u2018Low soluble P-selectin may facilitate early exclusion of acute myocardial infarction.\u2019 Clin Chem Acta<\/em>412 pp. 614-618.<\/p>\n\n\n\n

Background:<\/strong>Suspected cardiac chest pain accounts for over 25% of medical admissions but, as only a minority have acute coronary syndromes, there is a tremendous potential to reduce unnecessary admissions. We evaluated five markers of plaque rupture or instability as indicators that would allow safe early exclusion of acute myocardial infarction (AMI) at the time of presentation. <\/p>\n\n\n\n

Methods:<\/strong>Blood was drawn at the time of presentation from patients presenting to the Emergency Department with suspected cardiac chest pain and tested for cTnT and 5 novel biomarkers (pregnancy-associated plasma protein A (PAPP-A), thrombospondin, CD40 ligand, E-selectin and P-selectin). The primary outcome was a diagnosis of AMI. The secondary outcome was the occurrence of death, AMI or urgent revascularization (adverse cardiac events, ACE) within 30 days. <\/p>\n\n\n\n

Results:<\/strong>713 patients were included. Median time from symptom onset to venepuncture was 210 min. Only P-selectin and PAPP-A had value for diagnosis of AMI, with C-statistics of 0.68 (95% CI 0.63\u20130.73) and 0.57 (0.51\u20130.63) respectively. On multivariate analysis, P-selectin, cTnT and ECG ischemia independently predicted ACE. A model combining all three had 97.6% sensitivity, 52.8% specificity and 99.0% negative predictive value (NPV) for AMI. Use of this model could obviate the need for hospital admission in 44.2% of patients, 2.5% of whom would be expected to develop ACE. <\/p>\n\n\n\n

Conclusions:<\/strong>P-selectin has early diagnostic value for AMI and prognostic value independent of cTnT and ECG findings. The combination of P-selectin, cTnT and ECG has high NPV. Further research into this promising biomarker is warranted.<\/p>\n\n\nLink to Journal<\/span><\/a>","protected":false},"excerpt":{"rendered":"

Body, R., Pemberton, P., Ali, F., McDowell, G., Carley, S., Smith, A. & Mackway-Jones, K. (2011) \u2018Low soluble P-selectin may facilitate early exclusion of acute myocardial infarction.\u2019 Clin Chem Acta412 pp. 614-618. Background:Suspected cardiac chest pain accounts for over 25% of medical<\/p>\n","protected":false},"author":1,"featured_media":599,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"jetpack_post_was_ever_published":false,"_links_to":"","_links_to_target":""},"jetpack_shortlink":"https:\/\/wp.me\/P9tPlw-a4","jetpack-related-posts":[{"id":629,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=629","url_meta":{"origin":624,"position":0},"title":"Risk Factors and AMI","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G.,Carley, S. & Mackway-Jones, K. (2008) \u2018Do risk factors for chronic coronary heart disease help diagnose acute myocardial infarction in the emergency department.\u2019\u00a0Resuscitation79 pp. 41-45.\u00a0 Background:Hypertension, hyperlipidaemia, diabetes mellitus, tobacco smoking and a family history of premature coronary artery disease are known to be risk factors for the\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Risk-factors-for-ED-diagnosis-e1549807935709.png?fit=400%2C313&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":659,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=659","url_meta":{"origin":624,"position":1},"title":"MACS Rule","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S.,\u00a0McDowell, G., Pemberton, P., Burrows, G., Cook, G., Lewis, P.S., Smith, A., Mackway-Jones, K. (2014) \u2018The Manchester Acute Coronary Syndromes (MACS) decision rule for suspected cardiac chest pain: derivation and external validation.\u2019 Heart 100 pp. 1462-1468.\u00a0 Objective:We aimed to derive and validate a clinical decision rule (CDR)\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/MACS-Paper-e1549807711724.png?fit=400%2C331&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":641,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=641","url_meta":{"origin":624,"position":2},"title":"A FABP-ulous rule out strategy","date":"February 7, 2019","format":false,"excerpt":"Body, R.,\u00a0McDowell, G., Carley, S., Wibberley, C., Ferguson, J. & Mackway-Jones, K. (2011) \u2018A FABP-ulous rule out strategy? Heart fatty acid binding protein and troponin for rapid exclusion of acute myocardial infarction.\u2019\u00a0Resuscitation82 pp. 1041-1046.\u00a0 Objective:Many Emergency Departments (EDs) utilise \u2018triple marker\u2019 testing with CK-MB, myoglobin and troponin I (cTnI) to\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Quanti-HFABP-e1549807872944.png?fit=400%2C341&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":646,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=646","url_meta":{"origin":624,"position":3},"title":"Undetectable hs-cTnT","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S.,\u00a0McDowell, G., Jaffe, A.S., France, M., Cruickshank, K., Wibberley, C., Nuttall, M. & Mackway-Jones, K. (2011) \u2018Rapid exclusion of acute myocardial infarction in patients\u2019 with undetectable troponin using a high sensitivity assay.\u2019\u00a0J Am Coll Cardiol58 pp. 1332-1339. Objectives:This paper sought to evaluate whether high sensitivity troponin (hs-cTnT)\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/JACC-paper-e1549807840111.png?fit=400%2C268&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":637,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=637","url_meta":{"origin":624,"position":4},"title":"Symptoms and Signs in ACS","date":"February 7, 2019","format":false,"excerpt":"Body, R., Carley, S., Wibberley, C.,\u00a0McDowell, G., Ferguson, J. & Mackway- Jones, K. (2010) \u2018The value of symptoms and signs in the emergent diagnosis of acute coronary syndromes.\u2019\u00a0Resuscitation81 pp. 281-286.\u00a0 Objective:Patient history and physical examination are widely accepted as cornerstones of diagnosis in modern medicine. We aimed to assess the\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"https:\/\/i0.wp.com\/clinicalbiochemistry.net\/wp-content\/uploads\/2019\/01\/Symptoms-and-Signs-e1549807905811.png?fit=400%2C311&resize=350%2C200","width":350,"height":200},"classes":[]},{"id":549,"url":"http:\/\/clinicalbiochemistry.net\/?page_id=549","url_meta":{"origin":624,"position":5},"title":"PhD Project: BEST Study","date":"January 11, 2019","format":false,"excerpt":"Expediting the confirmation of acute myocardial infarction with point of care troponin and heart fatty acid binding protein testing to facilitate early intervention in emergency department Cardiac troponin is the reference standard biomarker for the diagnosis of acute myocardial infarction (AMI). In the appropriate clinical context, the detection of a\u2026","rel":"","context":"Similar post","img":{"alt_text":"","src":"","width":0,"height":0},"classes":[]}],"_links":{"self":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/624"}],"collection":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=624"}],"version-history":[{"count":3,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/624\/revisions"}],"predecessor-version":[{"id":627,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/pages\/624\/revisions\/627"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=\/wp\/v2\/media\/599"}],"wp:attachment":[{"href":"http:\/\/clinicalbiochemistry.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=624"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}