Role of soluble and platelet-bound P-selectin in discriminating cardiac from noncardiac chest pain at presentation in the emergency department

• Published in: The American heart journal Vol. 139; no. 2; pp. 320 - 328
• Main Authors: Gurbel, Paul A, Kereiakes, Dean J, Dalesandro, Margaret R, Bahr, Raymond D, O'Connor, Christopher M, Serebruany, Victor L
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-02-2000; Elsevier
• Subjects: Aged; Biological and medical sciences; Blood Platelets; Cardiology. Vascular system; Chest Pain - etiology; Coronary heart disease; Emergency Service, Hospital; Enzyme-Linked Immunosorbent Assay; Female; Flow Cytometry; Heart; Heart Failure - complications; Heart Failure - diagnosis; Humans; Male; Medical sciences; Middle Aged; Myocardial Ischemia - diagnosis; P-Selectin - blood; Pilot Projects; Sensitivity and Specificity; Human; P Selectin; Platelet; Pathogenesis; Cardiovascular disease; Angina pectoris; Coronary heart disease
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/S0002-8703(00)90242-4

Background It has been reported that selectins participate in the pathogenesis of acute coronary syndromes by modulating platelet-leukocyte-endothelium interactions. Elevated P-selectin level also has been observed in the clinical setting of myocardial ischemia and reperfusion; however, its utility in differentiating cardiac from noncardiac origins of chest pain is unknown.
Methods and Results Soluble and platelet fractions of P-selectin were measured for 122 patients with chest pain and 14 healthy persons acting as controls. Patients with a cardiac problem (unstable angina, congestive heart failure, acute myocardial infarction) had significantly elevated levels of soluble P-selectin (156.0 ± 58.8 ng/mL,
P =.002) and platelet-bound P-selectin (11.7% ± 6.4% positive cells,
P =.013) compared with the P-selectin profile among controls (102.6 ± 29.0 ng/mL, 4.1% ± 1.2% positivity) and among patients with noncardiac chest pain (114.7 ± 36.6 ng/mL, 5.7% ± 2.9% positivity). With a cutpoint of 10% positivity for membrane and 120 ng/mL for soluble P-selectin, the sensitivities were 0.442 and 0.558, and the specificities were 0.915 and 0.553.
Conclusions When a patient arrives in the emergency department, measurement of membrane P-selectin may serve as an additional diagnostic tool to detect heightened platelet activity, which is most prevalent among patients with a cardiac origin of chest pain. However, low sensitivity limits the utility of the P-selectin profile alone in suitably differentiating acute coronary syndromes within the overall population of patients with chest pain.