Serum plasminogen improves early detection of acute coronary syndrome in high sensitivity troponin t-negative chest pain patients
C Higa, L Otero, P demarchi, O Defelitto, A Pastorino, O Tupayachi Villagomez, V Creta, M J Gambarte, V Martinez, A MezzaliraAbstract
Background
Early diagnosis of acute coronary syndrome (ACS) in patients presenting with chest pain and normal high-sensitivity troponin remains challenging. Prothrombotic biomarkers may provide complementary diagnostic information in this setting.
Objective
To evaluate the diagnostic performance of plasminogen and other coagulation biomarkers for detecting ACS in patients admitted to a ER chest pain unit with initially normal high-sensitivity troponin T.
Methods
We conducted a prospective observational study including consecutive patients admitted to an emergency department chest pain protocol. High-sensitivity troponin T was measured at 0 and 3 hours. At admission, plasminogen, fibrinogen, fibrinogen degradation products, factor VIIIc, von Willebrand factor, and D-dimer were assessed. The serum samples collected and stored at -70°C and subsequently analyzed using IL coagulation systems and an ACL TOP 300 instrument VM. High-sensitivity troponin T was determined using a ROCHE ELECSYS analyzer. At the time of care, the researchers were blinded to the results of the thrombosis/thrombolysis markers.Patients receiving anticoagulation or heparin before sampling were excluded. The primary endpoint was in-hospital diagnosis of non-ST-elevation ACS. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed in all patients. For data comparison, statistics and ROC curve analysis we used a SPSS version 26 software.
Results
One hundred fifty six patients were included (mean age 62±12 years, 42% women); 32% were diagnosed with ACS. Using the best cut-off value (66 % activity), serum plasminogen showed a LR+ of 1.70 and a LR - of 0.53 for ACS diagnosis. In multivariable analysis, plasminogen was independently associated with ACS (OR 1.04 per each unit increase; 95% CI 1.00–1.08; p=0.040), Plasminogen showed the best diagnostic discrimination (AUC 0.74; 95% CI 0.55–0.93) compared with fibrinogen 0.59 (95% CI: 0.39–0.79) , factor VIIIc 0.49 (95% CI: 0.22–0.76), von Willebrand factor 0.52 (95% CI: 0.28–0.75) , and fibrinogen degradation products 0.46 (95% CI: 0.25–0.67), multiple paired De Long Test comparisons p < 0.05. .Serum plasminogen remained independently associated with ACS diagnosis after adjustment for age, sex, and ECG changes: OR 2.6 (IC 95% 0.849-8,406), p = 0.033 .
Conclusion
Our preliminary data demostrated that in patients presenting with suspected acute coronary syndrome and normal high-sensitivity troponin, serum plasminogen may be a useful tool for early risk stratification."