title: Role of soluble and platelet-bound P-selectin in discriminating cardiac from noncardiac chest pain at presentation in the emergency department.
abstract: 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.
  
  
  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.
authors.affiliation: Sinai Center for Thrombosis Research, Baltimore, MD 21215, USA. Heartdrug@aol.com
authors.forename: P A
authors.initials: PA
authors.lastname: Gurbel
authors.forename: D J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: M R
authors.initials: MR
authors.lastname: Dalesandro
authors.forename: R D
authors.initials: RD
authors.lastname: Bahr
authors.forename: C M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: V L
authors.initials: VL
authors.lastname: Serebruany
mesh_terms: D000368:Aged; D001792:Blood Platelets; D002637:Chest Pain / Q000209:etiology*; D004636:Emergency Service, Hospital; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis*; D019007:P-Selectin / Q000097:blood*; D010865:Pilot Projects; D012680:Sensitivity and Specificity
chemical_list: D019007:P-Selectin