Evaluation of coagulation markers for early diagnosis of acute coronary syndromes in the emergency room.
BACKGROUND
Diagnosis of acute coronary syndromes (ACS) is a major challenge for emergency physicians. Because soluble fibrin (sF) has been suggested as a potential early marker of impending myocardial ischemia, we were interested whether a sF bedside test could help in early identification of patients with ACS in the emergency department.


METHODS
We evaluated plasma coagulation markers, including a newly developed sF bedside test, prothrombin fragment (F(1+2)), sF, and D-dimer, in a cross-sectional trial with 184 patients suggestive of ACS.


RESULTS
Whereas 76% (13 of 17) of patients with unstable angina pectoris (UAP) had a positive sF bedside test, only 10 of 33 patients (30%) with non-ST-segment-elevation myocardial infarction and 10 of 44 patients (23%) with ST-elevation myocardial infarction tested positive. Three percent of controls (1 of 33) and 11% of patients (6 of 57) with preexisting stable angina had a positive sF bedside test (P <0.001 for noncardiac chest pain vs ACS), yielding an overall specificity of 92% and a sensitivity of 35%. The sensitivity of the established coagulation markers was significantly less to detect ACS (11% for F(1+2), 20% for thrombus precursor protein, and 18% for D-dimer; P <0.02 vs sF bedside test). The sF bedside test presented the earliest objective indicator of impending myocardial damage in the majority (10 of 13) of ACS patients with a normal or nondiagnostic electrocardiogram (ECG).


CONCLUSIONS
A sF bedside test offers a specific tool for early identification of patients with ACS in an emergency department setting, although its sensitivity seems sufficient only for the early identification of patients with UAP. A sF bedside test could be useful, particularly in UAP patients with a nondiagnostic ECG.
Derhaschnig
Ulla
U
Department of Emergency Medicine, Vienna University School of Medicine, A-1090 Vienna, Austria. Ulla.Derhaschnig@akh-wien.ac.at
Laggner
Anton N
AN
Röggla
Martin
M
Hirschl
Michael M
MM
Kapiotis
Stylianos
S
Marsik
Claudia
C
Jilma
Bernd
B
D000208:Acute Disease; D000789:Angina, Unstable / Q000175:diagnosis; D015415:Biomarkers / Q000097:blood; D001780:Blood Coagulation Tests; D004632:Emergency Medical Services; D005260:Female; D005337:Fibrin / Q000032:analysis*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000175:diagnosis*; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; C465961:thrombus precursor protein, human; D005337:Fibrin