Failure of thrombin generation markers to triage patients presenting with chest pain

Thrombin generation (TG) is an important pathogenic factor in acute coronar y syndromes including acute myocardial infarction (AMI). Since the diagnost ic utility of TG remains uncertain we sought to determine whether markers o f TG may triage patients presenting to the Emergency Department with chest pain. Soluble plasma levels of prothrombin fragment 1+2 (F1+2), and thrombi n/ antithrombin III complexes (TAT) were determined by ELISA in 80 patients presenting with chest pain to the Emergency Department and compared with 2 0 controls. There were no differences in TG markers between patients with n on-cardiac chest pain and healthy controls. Patients with unstable angina ( UA), and congestive heart failure (CHF) did not differ from controls with r espect to F1+2, and TAT was elevated in UA patients (6.05 +/- 1.15 ng/ml, p = 0.033) when compared with controls (3.34 +/- 0.20 ng/ml). Contrary to ex pectations, TAT levels at presentation with AMI were well below the concent rations observed in patiens with UA and CHF, Moreover, plasma F1+2 levels w ere significantly lower than in healthy controls (0.84 +/- 0.10 ng/ml versu s 1.22 +/- 0.11, p = 0.026). At the time of presentation to the Emergency D epartment, F1+2 and TAT failed to suitably triage patients with chest pain. The surprisingly low levels of TG markers in AMI patients before applying intensive therapy and reperfusion strategies deserves further investigation . Copyright (C) 2000 S. Karger AG, Basel.