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  • The value of haemostatic markers in the triage of patients with chest pain presenting with a normal or non-diagnostic ECG

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The value of haemostatic markers in the triage of patients with chest pain presenting with a normal or non-diagnostic ECG
  1. A H M Moons1,
  2. P M van der Zee1,
  3. R Bholasingh1,
  4. A Sturk2,
  5. C E Hack3,
  6. J C M Meijers4,
  7. O Kamp5,
  8. J H Cornel6,
  9. R J G Peters1,
  10. R J de Winter1
  1. 1Department of Cardiology, Academic Medical Centre, Amsterdam, the Netherlands
  2. 2Department of Clinical Chemistry, Academic Medical Centre, Amsterdam, the Netherlands
  3. 3Department of Pathophysiology of Plasma Proteins, Central Laboratory of the Netherlands Red Cross Blood Transfusion, Amsterdam, the Netherlands
  4. 4Department of Vascular Medicine, Academic Medical Centre, Amsterdam, the Netherlands
  5. 5Department of Cardiology, University Hospital VU, Amsterdam, the Netherlands
  6. 6Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
  1. Correspondence to:
    Dr Arno H M Moons
    Department of Cardiology, Academic Medical Centre, Room F3-241, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands; a.h.moonsamc.uva.nl

https://doi.org/10.1136/hrt.2004.039644

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    Among patients presenting with chest pain at the emergency department, the early diagnosis of acute coronary syndromes (ACS) is a major challenge for physicians. In 50–80% of the patients, the ECG is normal or non-diagnostic at presentation,1 which makes early differentiation from non-cardiac causes of chest pain difficult. Serial assessment of cardiac markers results in a high sensitivity to detect myocardial damage; however, the absence of evidence of myocardial damage does not exclude ACS. Therefore, novel early markers of ACS are needed. The main cause of ACS is atherosclerotic plaque disruption with superimposed arterial thrombus formation. Tissue factor induced thrombin generation has a pivotal role in this process.2 The purpose of this study was to evaluate the diagnostic value of coagulation markers (that is, markers of thrombin generation (prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin (TAT) complexes), soluble tissue factor, and tissue factor pathway inhibitor (TFPI) activity) and a fibrinolytic marker (plasminogen activator inhibitor (PAI)) for the early identification of ACS in patients presenting to the emergency department with chest pain and a normal or non-diagnostic ECG.

    METHODS

    We performed a nested case–control study within a cohort of patients with chest pain presenting to the emergency department with a normal or non-diagnostic ECG within six hours after symptoms onset. Patients were observed in the emergency department for ⩽ 24 hours before discharge or hospital admission. Cardiac troponin T (cTnT) was assessed on admission and at …

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