PMID- 34933919
OWN - NLM
STAT- MEDLINE
DCOM- 20221026
LR  - 20240214
IS  - 1472-0213 (Electronic)
IS  - 1472-0205 (Print)
IS  - 1472-0205 (Linking)
VI  - 39
IP  - 11
DP  - 2022 Nov
TI  - Monocyte chemoattractant protein-1 is not predictive of cardiac events in 
      patients with non-low-risk chest pain.
PG  - 853-858
LID - 10.1136/emermed-2021-211266 [doi]
AB  - 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.
CI  - (c) Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Ashburn, Nicklaus P
AU  - Ashburn NP
AUID- ORCID: 0000-0002-3466-8813
AD  - Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, 
      North Carolina, USA N.Ashburn@wakehealth.edu.
AD  - Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North 
      Carolina, USA.
FAU - Snavely, Anna C
AU  - Snavely AC
AD  - Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, 
      North Carolina, USA.
AD  - Department of Biostatistics and Data Science, Wake Forest School of Medicine, 
      Winston-Salem, North Carolina, USA.
FAU - Allen, Brandon R
AU  - Allen BR
AD  - Department of Emergency Medicine, University of Florida College of Medicine, 
      Gainesville, Florida, USA.
FAU - Christenson, Robert H
AU  - Christenson RH
AD  - Department of Pathology, University of Maryland School of Medicine, Baltimore, 
      Maryland, USA.
FAU - Herrington, David M
AU  - Herrington DM
AD  - Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, North 
      Carolina, USA.
FAU - Hiestand, Brian C
AU  - Hiestand BC
AD  - Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, 
      North Carolina, USA.
FAU - Miller, Chadwick D
AU  - Miller CD
AD  - Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, 
      North Carolina, USA.
FAU - Stopyra, Jason P
AU  - Stopyra JP
AD  - Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, 
      North Carolina, USA.
FAU - Mahler, Simon A
AU  - Mahler SA
AD  - Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, 
      North Carolina, USA.
AD  - Departments of Epidemiology and Prevention and Implementation Science, Wake 
      Forest School of Medicine, Winston-Salem, North Carolina, USA.
LA  - eng
GR  - HHSN268201500003C/HL/NHLBI NIH HHS/United States
GR  - R01 HL133932/HL/NHLBI NIH HHS/United States
GR  - U01 HL123027/HL/NHLBI NIH HHS/United States
GR  - R01 HL118263/HL/NHLBI NIH HHS/United States
GR  - KL2 TR001421/TR/NCATS NIH HHS/United States
GR  - UL1 TR001420/TR/NCATS NIH HHS/United States
GR  - UH3 AT009149/AT/NCCIH NIH HHS/United States
GR  - HHSN268201500003I/HL/NHLBI NIH HHS/United States
GR  - R01 HL111362/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Multicenter Study
DEP - 20211221
PL  - England
TA  - Emerg Med J
JT  - Emergency medicine journal : EMJ
JID - 100963089
RN  - 0 (Chemokine CCL2)
RN  - 0 (Troponin)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Case-Control Studies
MH  - *Chemokine CCL2/blood
MH  - Chest Pain/etiology
MH  - *Emergency Service, Hospital
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Troponin
PMC - PMC9209560
MID - NIHMS1783150
OTO - NOTNLM
OT  - acute coronary syndrome
OT  - acute myocardial infarct
OT  - cardiac care
OT  - chest
OT  - diagnosis
COIS- 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 receives research funding from 
      Roche Diagnostics and Beckman Coulter. He is a consultant for Roche Diagnostics. 
      RHC is a consultant for and receives funding from Roche Diagnostics, Siemens 
      Healthineers, Beckman Coulter Diagnostics, Becton Dickinson and Company, Quidel 
      Corporation and Sphingotec. DMH receives support from the North Carolina State 
      Legislature, Centers for Disease Control and Prevention, NHLBI/NIH (R01 
      HL0133932, 2R01HL11136, HHSN268201500003I, UH3AT009149), AstraZeneca, DalCor 
      Pharma, Amgen and Esperion. BH has received research funding from Siemens. CDM 
      receives research funding from Siemens, Abbott Point of Care, Creavo Medical 
      Technologies, Grifols and NHLBI (5U01HL123027, 1 R01 HL118263). He has a US 
      patent on cardiac biomarkers for coronary artery disease not related to MCP-1. 
      JPS receives research funding from NCATS/NIH (KL2TR001421), HRSA 
      (H2ARH39976-01-00), NHLBI (U01HL123027), Roche Diagnostics, and Abbott Point of 
      Care. SAM receives funding/support from Roche Diagnostics, Abbott Laboratories, 
      Ortho Clinical Diagnostics, Siemens, Grifols, Pathfast, Quidel, Genetesis AHRQ, 
      PCORI, NIDA and NHLBI (1RO1HL118263-01), and HRSA (1H2ARH399760100). He is a 
      consultant for Roche and Amgen and the Chief Medical Officer for Impathiq.
EDAT- 2021/12/23 06:00
MHDA- 2022/10/26 06:00
PMCR- 2022/11/01
CRDT- 2021/12/22 05:59
PHST- 2021/02/04 00:00 [received]
PHST- 2021/12/10 00:00 [accepted]
PHST- 2021/12/23 06:00 [pubmed]
PHST- 2022/10/26 06:00 [medline]
PHST- 2021/12/22 05:59 [entrez]
PHST- 2022/11/01 00:00 [pmc-release]
AID - emermed-2021-211266 [pii]
AID - 10.1136/emermed-2021-211266 [doi]
PST - ppublish
SO  - Emerg Med J. 2022 Nov;39(11):853-858. doi: 10.1136/emermed-2021-211266. Epub 2021 
      Dec 21.