title: Soluble intercellular adhesion molecule-1 as a predictor of early adverse events in patients with chest pain compatible with myocardial ischemia.
abstract: OBJECTIVE
  Inflammation plays an important role in acute coronary syndromes, and some evidence indicates that patients with a more pronounced vascular inflammatory response have a poorer outcome. Soluble intercellular adhesion molecule-1 (sICAM-1) is a specific marker for vascular endothelial cell activation. The aim of this study was to investigate the prognostic value of plasma sICAM-1 levels in patients with acute chest pain compatible with myocardial ischemia.
  
  
  METHODS
  This prospective study was conducted at 2 urban university medical centers. The study cohort consisted of 119 consecutive patients with chest pain in whom myocardial ischemia was suspected clinically at presentation. Patients with conditions that affect sICAM-1 levels were ineligible. Cardiac troponin I (cTnI), C-reactive protein, and sICAM-1 levels were assayed at presentation to the emergency department. The primary end point was the occurrence of a serious cardiac event (death, nonfatal acute myocardial infarction, coronary revascularization) in the hospital.
  
  
  RESULTS
  Although sICAM-1 levels tended to be higher in patients with a serious cardiac event, there was no significant association. In contrast, a cTnI level greater than 0.2 ng/mL was a powerful predictor of an in-hospital serious cardiac event (odds ratio 16.3, 95% confidence interval [CI] 4.7 to 55.9; P <.0001). Soluble ICAM-1 levels of more than 260 ng/mL at presentation had a sensitivity for predicting a serious cardiac event of 63% (95% CI 46% to 81%) but a specificity of only 47% (95% CI 38% to 57%).
  
  
  CONCLUSIONS
  In a heterogeneous population of patients with chest pain compatible with myocardial ischemia, elevated sICAM-1 levels are poor predictors of an individual patient suffering a serious cardiac event in the hospital.
authors.affiliation: Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA. grahamhillis@hotmail.com
authors.forename: G S
authors.initials: GS
authors.lastname: Hillis
authors.forename: C
authors.initials: C
authors.lastname: Terregino
authors.forename: P
authors.initials: P
authors.lastname: Taggart
authors.forename: A
authors.initials: A
authors.lastname: Killian
authors.forename: N
authors.initials: N
authors.lastname: Zhao
authors.forename: J
authors.initials: J
authors.lastname: Kaplan
authors.forename: W C
authors.initials: WC
authors.lastname: Dalsey
authors.forename: A
authors.initials: A
authors.lastname: Mangione
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood / Q000175:diagnosis*; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis*; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk
chemical_list: D018799:Intercellular Adhesion Molecule-1