Hillis G S, Terregino C, Taggart P, Killian A, Zhao N, Kaplan J, Dalsey W C, Mangione A
Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
Ann Emerg Med. 2001 Sep;38(3):223-8. doi: 10.1067/mem.2001.117199.
Inflammation plays an important role in acute coronary syndromes, and some evidence indicates that patients with a more pronounced vascular inflammatory response have a poorer outcome. Soluble intercellular adhesion molecule-1 (sICAM-1) is a specific marker for vascular endothelial cell activation. The aim of this study was to investigate the prognostic value of plasma sICAM-1 levels in patients with acute chest pain compatible with myocardial ischemia.
This prospective study was conducted at 2 urban university medical centers. The study cohort consisted of 119 consecutive patients with chest pain in whom myocardial ischemia was suspected clinically at presentation. Patients with conditions that affect sICAM-1 levels were ineligible. Cardiac troponin I (cTnI), C-reactive protein, and sICAM-1 levels were assayed at presentation to the emergency department. The primary end point was the occurrence of a serious cardiac event (death, nonfatal acute myocardial infarction, coronary revascularization) in the hospital.
Although sICAM-1 levels tended to be higher in patients with a serious cardiac event, there was no significant association. In contrast, a cTnI level greater than 0.2 ng/mL was a powerful predictor of an in-hospital serious cardiac event (odds ratio 16.3, 95% confidence interval [CI] 4.7 to 55.9; P <.0001). Soluble ICAM-1 levels of more than 260 ng/mL at presentation had a sensitivity for predicting a serious cardiac event of 63% (95% CI 46% to 81%) but a specificity of only 47% (95% CI 38% to 57%).
In a heterogeneous population of patients with chest pain compatible with myocardial ischemia, elevated sICAM-1 levels are poor predictors of an individual patient suffering a serious cardiac event in the hospital.
炎症在急性冠状动脉综合征中起重要作用，一些证据表明血管炎症反应更明显的患者预后较差。可溶性细胞间黏附分子-1（sICAM-1）是血管内皮细胞活化的特异性标志物。本研究旨在探讨血浆sICAM-1水平在伴有心肌缺血的急性胸痛患者中的预后价值。
本前瞻性研究在两家城市大学医学中心进行。研究队列包括119例连续出现胸痛的患者，这些患者在就诊时临床上怀疑有心肌缺血。患有影响sICAM-1水平疾病的患者不符合入选标准。在急诊科就诊时检测心肌肌钙蛋白I（cTnI）、C反应蛋白和sICAM-1水平。主要终点是住院期间发生严重心脏事件（死亡、非致命性急性心肌梗死、冠状动脉血运重建）。
虽然发生严重心脏事件的患者sICAM-1水平往往较高，但两者之间无显著关联。相比之下，cTnI水平大于0.2 ng/mL是住院期间发生严重心脏事件的有力预测指标（优势比16.3，95%置信区间[CI] 4.7至55.9；P < .0001）。就诊时sICAM-1水平超过260 ng/mL对严重心脏事件的预测敏感性为63%（95% CI 46%至81%），但特异性仅为47%（95% CI 38%至57%）。
在伴有心肌缺血的胸痛患者这一异质性人群中，sICAM-1水平升高对预测个体患者在医院发生严重心脏事件的价值不大。
