title: Soluble urokinase plasminogen activator receptor for risk prediction in patients admitted with acute chest pain.
abstract: BACKGROUND
  Plasma concentrations of soluble urokinase plasminogen activator receptor (suPAR) predict mortality in several clinical settings, but the long-term prognostic importance of suPAR in chest pain patients admitted on suspicion of non-ST-segment elevation acute coronary syndrome (NSTEACS) is uncertain.
  
  
  METHODS
  suPAR concentrations were measured on admission in 449 consecutive chest pain patients in a single center between January 3, 2005, and February 14, 2006. Patients were followed for all-cause mortality from discharge until July 28, 2011.
  
  
  RESULTS
  The diagnoses at discharge comprised high-risk NSTEACS [non-ST elevation myocardial infarction or unstable angina with electrocardiogram (ECG) abnormalities] in 77 patients (17.2%) and low-risk NSTEACS without evidence of myocardial ischemia in 257 (57.2%) of patients. Another 115 (25.6%) of patients received other diagnoses. During a median follow-up of 5.7 years (range, 0.01-6.6 years) there were 162 (36.1%) deaths. suPAR was predictive of mortality independent of age, sex, smoking, final diagnosis for the hospitalization, comorbidities (diabetes, hypertension, previous myocardial infarction, and heart failure), and variables measured on the day of admission (renal function, inflammatory markers, and markers of myocardial ischemia) with a hazard ratio (95% CI) of 1.93 (1.48-2.51) per SD increase in log-transformed suPAR, P < 0.0001. The use of suPAR improved the predictive accuracy of abnormal ECG findings and increased troponin concentrations regarding all-cause mortality (c statistics, 0.751-0.805; P < 0.0001).
  
  
  CONCLUSIONS
  suPAR is a strong predictor of adverse long-term outcomes and improves risk stratification beyond traditional risk variables in chest pain patients admitted with suspected NSTEACS.
authors.affiliation: Copenhagen University Hospital, Glostrup, Denmark;
authors.forename: Stig
authors.initials: S
authors.lastname: Lyngbæk
authors.forename: Charlotte
authors.initials: C
authors.lastname: Andersson
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Marott
authors.forename: Daniél V
authors.initials: DV
authors.lastname: Møller
authors.forename: Michael
authors.initials: M
authors.lastname: Christiansen
authors.forename: Kasper K
authors.initials: KK
authors.lastname: Iversen
authors.forename: Peter
authors.initials: P
authors.lastname: Clemmensen
authors.forename: Jesper
authors.initials: J
authors.lastname: Eugen-Olsen
authors.forename: Peter R
authors.initials: PR
authors.lastname: Hansen
authors.forename: Jørgen L
authors.initials: JL
authors.lastname: Jeppesen
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D002637:Chest Pain / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D055293:Receptors, Urokinase Plasminogen Activator / Q000097:blood*; D012189:Retrospective Studies; D018570:Risk Assessment; D020107:Troponin T / Q000097:blood
chemical_list: D055293:Receptors, Urokinase Plasminogen Activator; D020107:Troponin T