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


Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Gurbel, PA; Kereiakes, DJ; Dalesandro, MR; Bahr, RD; O'Connor, CM; Serebruany, VL

Published Date

  • February 2000

Published In

Volume / Issue

  • 139 / 2 Pt 1

Start / End Page

  • 320 - 328

PubMed ID

  • 10650306

Pubmed Central ID

  • 10650306

International Standard Serial Number (ISSN)

  • 0002-8703

Digital Object Identifier (DOI)

  • 10.1067/mhj.2000.101109


  • eng

Conference Location

  • United States