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Departments of
1
Emergency Medicine,
2 Medical and Chemical Laboratory Diagnostics, and
3 Clinical Pharmacology, Vienna University, A-1090 Vienna, Austria.
aAddress correspondence to this author at: Department of Emergency Medicine, Vienna University School of Medicine, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Fax 43-1-40400/1965; e-mail Ulla.Derhaschnig{at}akh-wien.ac.at.
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 (F1+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 F1+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.
The following articles in journals at HighWire Press have cited this article:
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  J. L. Mega, D. A. Morrow, J. A. de Lemos, S. Mohanavelu, C. P. Cannon, and M. S. Sabatine Thrombus precursor protein and clinical outcomes in patients with acute coronary syndromes. J. Am. Coll. Cardiol., June 24, 2008; 51(25): 2422 - 2429. [Abstract] [Full Text] [PDF]
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 M. Frossard, I. Fuchs, J. M. Leitner, K. Hsieh, M. Vlcek, H. Losert, H. Domanovits, W. Schreiber, A. N. Laggner, and B. Jilma Platelet Function Predicts Myocardial Damage in Patients With Acute Myocardial Infarction Circulation, September 14, 2004; 110(11): 1392 - 1397. [Abstract] [Full Text] [PDF]
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 B. Lumbreras-Lacarra, J. M. Ramos-Rincon, and I. Hernandez-Aguado Methodology in Diagnostic Laboratory Test Research in Clinical Chemistry and Clinical Chemistry and Laboratory Medicine Clin. Chem., March 1, 2004; 50(3): 530 - 536. [Abstract] [Full Text] [PDF]
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 C. Marsik, M. Graninger, N. Mackman, B. Osterud, T. Luther, and B. Jilma Effects of enalapril on disseminated intravascular thrombin formation during systemic inflammation Cardiovasc Res, October 15, 2003; 60(1): 131 - 135. [Abstract] [Full Text] [PDF]
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