ABSTRACT
BACKGROUND: The major limitation of current diagnostic methods for the rapid diagnosis of an acute myocardial infarction (AMI) involves the measurement of the effects of ischemic or necrotic processes on myocardial function rather than the detection of the precipitating thrombotic event. The utility of an assay was investigated for thrombus precursor protein (TpP) in the diagnosis of 115 patients with symptoms consistent with myocardial ischemia or infarction of less than six hours in duration. Samples from patients were drawn at 0, 1, 2, 4, 8, 16, and 24 hours post presentation, and creatine kinase, CK-MB, myoglobin, troponin I, and TpP concentrations were determined. Significantly abnormal concentrations of TpP were observed in 15 of 17 patients presenting with an AMI within 6 hours of the onset of symptoms (p < 0.00001), 2 of 8 patients presenting with an AMI after 6 hours from the onset of symptoms (p = 0.0077), 22 of 35 patients with unstable angina (p = 0.00035), 15 of 30 patients with angina (p = 0.00024), 3 of 5 patients with atrial fibrillation (P = 0.00005), 6 of 9 patients with congestive heart failure (p = 0.00002), and 6 of 11 patients with non-cardiac chest pain (p = 0.00139). Non-cardiac chest pain patients with gastroenteritis, esophageal spasm, duodenal ulcer, cocaine overdose, and pericarditis presented with abnormal plasma concentrations of thrombus precursor protein. Peak concentrations of TpP in patients with AMI preceded those of the other markers by two to four hours.
