title: Choline for diagnosis and prognostication of acute coronary syndromes in the Emergency Department.
abstract: OBJECTIVE
  Choline has been identified as a promising marker of coronary inflammation, plaque destabilisation and ischaemia. We sought to evaluate plasma choline levels for rapid confirmation or exclusion of acute myocardial infarction (AMI) in the Emergency Department (ED) and for predicting major adverse cardiac events (MACE).
  
  
  METHODS
  We prospectively recruited 361 patients who presented to the ED with suspected cardiac chest pain within the previous 24 h. Blood was drawn at the time of presentation for plasma choline levels. All patients underwent troponin T testing > or = 12 h after symptom onset and were followed up for the occurrence of MACE within 6 months. Whole blood choline (WBCho) levels were also measured in a convenience sample of 39 patients.
  
  
  RESULTS
  Plasma choline levels did not help to predict a diagnosis of AMI (odds ratio (OR) 1.00 (95% confidence intervals (CI) 0.91-1.10, p = 0.98). For a diagnosis of AMI the area under the receiver operating characteristic (ROC) curve was 0.48. Plasma choline was not predictive of the combined endpoint of MACE (OR 1.03, 95% CI 0.95-1.12, p = 0.45) but predicted AMI within 6 months (OR 1.31, 95% CI 1.09-1.56, p = 0.003). WBCho levels were significantly different to plasma levels and were predictive of MACE.
  
  
  CONCLUSIONS
  Plasma choline, measured at the time of ED presentation, is not a diagnostic marker of AMI but predicts AMI within 6 months. While plasma choline failed to predict MACE, WBCho was predictive and warrants further evaluation.
authors.affiliation: Emergency Department, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, United Kingdom. rbody@doctors.org.uk
authors.forename: Richard
authors.initials: R
authors.lastname: Body
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Griffith
authors.forename: Brian
authors.initials: B
authors.lastname: Keevil
authors.forename: Garry
authors.initials: G
authors.lastname: McDowell
authors.forename: Simon
authors.initials: S
authors.lastname: Carley
authors.forename: Jamie
authors.initials: J
authors.lastname: Ferguson
authors.forename: Kevin
authors.initials: K
authors.lastname: Mackway-Jones