title: Elevated soluble P-selectin levels are associated with an increased risk of early adverse events in patients with presumed myocardial ischemia.
abstract: BACKGROUND
  Cell adhesion molecules (CAMs) play a pivotal role in the interactions between leukocytes, platelets, and vascular endothelium. Soluble CAMs (sCAMs) are shed from cell surfaces and reflect cellular activation. Elevated levels of sCAMs have been reported in the acute coronary syndromes. We hypothesized, therefore, that sCAMs might prove of prognostic value in patients with acute chest pain presumed to be the result of myocardial ischemia.
  
  
  METHODS
  One hundred twenty-six consecutive patients with chest pain, thought clinically to represent myocardial ischemia, were studied prospectively. Soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), E-selectin (sE-selectin) and P-selectin (sP-selectin) levels were assayed at presentation, as were cardiac troponin I (cTnI) and creatine kinase-MB(mass) (CK-MB(mass)). The primary study end point was the occurrence of a serious cardiac event (SCE) during the index admission or the subsequent 3 months.
  
  
  RESULTS
  sP-selectin and cTnI levels were significantly higher among patients who had an early SCE (P =.006 and P <.001, respectively). Both remained independently predictive (P <.001) in a multivariate regression equation. The other independent predictor was a history of vascular disease (P <.05). No other markers were significant predictors of early outcome.
  
  
  CONCLUSIONS
  Elevated sP-selectin levels, but not those of other sCAMs, are predictors of early adverse events in patients with chest pain presumed caused by myocardial ischemia. Their utility in predicting the outcome of individual patients is, however, limited.
authors.affiliation: Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, Pa, USA. grahamhillis@hotmail.com
authors.forename: Graham S
authors.initials: GS
authors.lastname: Hillis
authors.forename: Carol
authors.initials: C
authors.lastname: Terregino
authors.forename: Pamela
authors.initials: P
authors.lastname: Taggart
authors.forename: Anthony
authors.initials: A
authors.lastname: Killian
authors.forename: Ning
authors.initials: N
authors.lastname: Zhao
authors.forename: William C
authors.initials: WC
authors.lastname: Dalsey
authors.forename: Antoinette
authors.initials: A
authors.lastname: Mangione
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015815:Cell Adhesion Molecules / Q000097:blood*; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D019040:E-Selectin / Q000097:blood; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood*; D019007:P-Selectin / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D019210:Troponin I / Q000097:blood; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
chemical_list: D015415:Biomarkers; D015815:Cell Adhesion Molecules; D019040:E-Selectin; D007527:Isoenzymes; D019007:P-Selectin; D019210:Troponin I; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form