Diagnostic evaluation of the MRP-8/14 for the emergency assessment of chest pain
- 163 Downloads
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.
KeywordsBiomarkers Unstable angina Myocardial infarction Platelets
Reagent support was provided by Buhlmann Laboratories AG, Switzerland.
Conflicts of interest
The TIMI Study Group has received significant research grant support from Accumetrics, Astra-Zeneca, Bayer Healthcare, Beckman Coulter, Biosite, Bristol-Myers Squibb, CV Therapeutics, Daiichi Sankyo, Eli Lilly and Co, GlaxoSmithKline, Merck and Company, Nanosphere, Novartis Pharmaceuticals, Ortho-Clinical Diagnostics, Pfizer, Roche Diagnostics, Sanofi-Aventis, Schering-Plough, Siemens, and Singulex. Dr. Jarolim has consulted for T2 Biosystems and Quanterix and has received grant support from Daiichi Sankyo, Roche Diagnostics, Amgen, BRAMS, Abbott, and Merck and Co. Dr. Croce was supported in part by NHLBI grant K08HL086672. Dr. Sabatine was supported in part by grant R01 HL096738, grant R01 HL098280, and contract HHSN268201000033C from the NHLBI. Dr. Sabatine also receives research grant support from Abbott, BRAHMS, Critical Diagnostics, Nanosphere, and Roche Diagnostics. Dr. Simon was supported in part by National Institutes of Health grant to DIS (HL57506 MERIT Award). Dr. Morrow has received honoraria for educational presentations from CV Therapeutics, and Sanofi-Aventis. He has served as a consultant for Beckman Coulter, Sanofi-Aventis, Schering Plough, and Siemens. Ms. Murphy and Drs. Bonaca, and Ruff have no additional relationships to report.
- 1.Wright RS et al (2011) ACCF/AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 57(19):e215–367PubMedCrossRefGoogle Scholar
- 2.Kushner FG et al (2009) Focused updates: ACC/AHA guidelines for the management of patients with ST-Elevation Myocardial Infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 54(23):2205–2241PubMedCrossRefGoogle Scholar
- 8.Morrow DA et al (2008) Myeloid-related protein 8/14 and the risk of cardiovascular death or myocardial infarction after an acute coronary syndrome in the Pravastatin or Atorvastatin Evaluation and Infection Therapy: thrombolysis in myocardial infarction (PROVE IT-TIMI 22) trial. Am Heart J 155(1):49–55PubMedCrossRefGoogle Scholar
- 13.Buhlmann Laboratories AG MRP 8/14 ELISA Package Insert (2009)Google Scholar