Article

Journal of Thrombosis and Thrombolysis

, Volume 34, Issue 2, pp 229-234

Diagnostic evaluation of the MRP-8/14 for the emergency assessment of chest pain

  • Amit N. VoraAffiliated withTIMI Study Group, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
  • , Marc P. BonacaAffiliated withTIMI Study Group, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School Email author 
  • , Christian T. RuffAffiliated withTIMI Study Group, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
  • , Petr JarolimAffiliated withDepartment of Pathology, Brigham and Women’s Hospital, Harvard Medical School
  • , Sabina MurphyAffiliated withTIMI Study Group, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
  • , Kevin CroceAffiliated withCardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
  • , Marc S. SabatineAffiliated withTIMI Study Group, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School
  • , Daniel I. SimonAffiliated withHarrington-McLaughlin Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine
  • , David A. MorrowAffiliated withTIMI Study Group, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School

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Abstract

Elevated levels of myeloid-related protein (MRP)-8/14 (S100A8/A9) are associated with first cardiovascular events in healthy individuals and worse prognosis in patients with acute coronary syndrome (ACS). The diagnostic utility of MRP-8/14 in patients presenting to the emergency room with symptoms concerning for ACS is uncertain. MRP-8/14 was measured in serial serum and plasma samples in a single center prospective cohort-study of patients presenting to the emergency room with non-traumatic chest pain concerning for ACS. Final diagnosis was adjudicated by an endpoint committee. Of patients with baseline MRP-8/14 results (n = 411), the median concentration in serum was 1.57 μg/ml (25th, 75th: 0.87, 2.68) and in plasma was 0.41 μg/ml (<0.4, 1.15) with only moderate correlation between serum and plasma (ρ = 0.40). A final diagnosis of MI was made in 106 (26%). Peak serum MRP-8/14 was higher in patients presenting with MI (p < 0.001). However, the overall diagnostic performance of MRP-8/14 was poor: sensitivity 28% (95% CI 20–38), specificity 82% (78–86), positive predictive value 36% (26–47), and negative predictive value 77% (72–81). The area under the ROC curve for diagnosis of MI with MRP-8/14 was 0.55 (95% CI 0.51–0.60) compared with 0.95 for cTnI. The diagnostic performance was not improved in early-presenters, patients with negative initial cTnI, or using later MRP-8/14 samples. Patients presenting with MI had elevated levels of serum MRP-8/14 compared to patients with non-cardiac chest pain. However, overall diagnostic performance of MRP-8/14 was poor and neither plasma nor serum MRP-8/14 offered diagnostic utility comparable to cardiac troponin.

Keywords

Biomarkers Unstable angina Myocardial infarction Platelets