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Ashburn NP, Snavely AC, Allen BR, et al. Monocyte chemoattractant protein-1 is not predictive of cardiac events in patients with non-low-risk chest pain. Emerg Med J. 2021;doi: 10.1136/emermed-2021-211266.
Ashburn, N. P., Snavely, A. C., Allen, B. R., Christenson, R. H., Herrington, D. M., Hiestand, B. C., Miller, C. D., Stopyra, J. P., & Mahler, S. A. (2021). Monocyte chemoattractant protein-1 is not predictive of cardiac events in patients with non-low-risk chest pain. Emergency medicine journal : EMJ, . https://doi.org/10.1136/emermed-2021-211266
Ashburn, Nicklaus P, et al. "Monocyte chemoattractant protein-1 is not predictive of cardiac events in patients with non-low-risk chest pain." Emergency medicine journal : EMJ vol. (2021). doi: https://doi.org/10.1136/emermed-2021-211266
Ashburn NP, Snavely AC, Allen BR, Christenson RH, Herrington DM, Hiestand BC, Miller CD, Stopyra JP, Mahler SA. Monocyte chemoattractant protein-1 is not predictive of cardiac events in patients with non-low-risk chest pain. Emerg Med J. 2021 Dec 21; doi: 10.1136/emermed-2021-211266. Epub 2021 Dec 21. PMID: 34933919.
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Emerg Med J. 2021 Dec 21; doi: 10.1136/emermed-2021-211266. Epub 2021 Dec 21.

Monocyte chemoattractant protein-1 is not predictive of cardiac events in patients with non-low-risk chest pain.

Emergency medicine journal : EMJ

Nicklaus P Ashburn, Anna C Snavely, Brandon R Allen, Robert H Christenson, David M Herrington, Brian C Hiestand, Chadwick D Miller, Jason P Stopyra, Simon A Mahler

Affiliations

  1. Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA [email protected].
  2. Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  3. Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  4. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
  5. Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
  6. Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
  7. Departments of Epidemiology and Prevention and Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

PMID: 34933919 DOI: 10.1136/emermed-2021-211266

Abstract

BACKGROUND: Prior studies suggest monocyte chemoattractant protein-1 (MCP-1) may be useful for risk stratifying ED patients with chest pain. We hypothesise that MCP-1 will be predictive of 90-day major adverse cardiovascular events (MACEs) in non-low-risk patients.

METHODS: A case-control study was nested within a prospective multicentre cohort (STOP-CP), which enrolled adult patients being evaluated for acute coronary syndrome at eight US EDs from 25 January 2017 to 06 September 2018. Patients with a History, ECG, Age, and Risk factor score (HEAR score) ≥4 or coronary artery disease (CAD), a non-ischaemic ECG, and non-elevated contemporary troponins at 0 and 3 hours were included. Cases were patients with 90-day MACE (all-cause death, myocardial infarction or revascularisation). Controls were patients without MACE selected with frequency matching using age, sex, race, and HEAR score or the presence of CAD. Serum MCP-1 was measured. Sensitivity and specificity were determined for cut-off points of 194 pg/mL, 200 pg/mL, 238 pg/mL and 281 pg/mL. Logistic regression adjusting for age, sex, race, and HEAR score/presence of CAD was used to determine the association between MCP-1 and 90-day MACE. A separate logistic model also included high-sensitivity troponin (hs-cTnT).

RESULTS: Among 40 cases and 179 controls, there was no difference in age (p=0.90), sex (p=1.00), race (p=0.85), or HEAR score/presence of CAD (p=0.89). MCP-1 was similar in cases (median 191.9 pg/mL, IQR: 161.8-260.1) and controls (median 196.6 pg/mL, IQR: 163.0-261.1) (p=0.48). At a cut-off point of 194 pg/mL, MCP-1 was 50.0% (95% CI 33.8% to 66.2%) sensitive and 46.9% (95% CI 39.4% to 54.5%) specific for 90-day MACE. After adjusting for covariates, MCP-1 was not associated with 90-day MACE at any cut-off point (at 194 pg/mL, OR 0.88 (95% CI 0.43 to 1.79)). When including hs-cTnT in the model, MCP-1 was not associated with 90-day MACE at any cut-off point (at 194 pg/mL, OR 0.85 (95% CI 0.42 to 1.73)).

CONCLUSION: MCP-1 is not predictive of 90-day MACE in patients with non-low-risk chest pain.

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: acute coronary syndrome; acute myocardial infarct; cardiac care; chest; diagnosis

Conflict of interest statement

Competing interests: NPA receives research funding from the Emergency Medicine Foundation (EMF18_EMRA_RESR_0012). ACS receives funding from NHLBI (1RO1HL118263-01) and HRSA (1H2ARH399760100). BA recei

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