To rule out acute myocardial infarction (AMI) in chest pain patients constitutes a diagnostic challenge to emergency department (ED) physicians.
To evaluate the diagnostic value of measuring salivary alpha-amylase (sAA) activity for detecting AMI in patients presenting to the ED with acute chest pain.
sAA activity was measured in a prospective cohort of 473 consecutive adult patients within 4 h of onset of chest pain. Comparisons were made between patients with a final diagnosis of AMI and those with non-AMI. Univariate analysis and multiple logistic regression model were used to identify independent clinical predictors of AMI.
Initial sAA activity in the AMI group (n = 85; 266 ± 127.6 U/mL) was significantly higher than in the non-AMI group (n = 388; 130 ± 92.8 U/mL, p < 0.001). sAA activity levels were also significantly higher in patients with ST elevation AMI (n = 53) compared to in those with non-ST elevation AMI (n = 32) (300 ± 141.1 vs. 210 ± 74.1 U/mL, p < 0.001). The area under the receiver operating characteristic curve of sAA activity for predicting AMI in patients with acute chest pain was 0.826 (95% confidence interval [CI] 0.782–0.869), with diagnostic odds ratio 10.87 (95% CI 6.16–19.18). With a best cutoff value of 197.7 U/mL, the sAA activity revealed moderate sensitivity and specificity as an independent predictor of AMI (78.8% and 74.5%).
High initial sAA activity is an independent predictor of AMI in patients presenting to the ED with chest pain.
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- Early invasive versus conservative strategies for unstable angina and non-ST elevation myocardial infarction in the stent era.Cochrane Database Syst Rev. 2010; : CD004815
- Evaluation of chest pain in the emergency department.Curr Probl Cardiol. 1997; 22: 149-236
- Comprehensive strategy for the evaluation and triage of the chest pain patient.Ann Emerg Med. 1997; 29: 116-125
- Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction.N Engl J Med. 1994; 331: 561-566
- Wu A.H.B. Cardiac markers (pathology and laboratory medicine). 2nd edn. Humana Press, Totowa, NJ2003
- The role of single ECG, creatinine kinase, and CKMB in diagnosing patients with acute chest pain.Am J Emerg Med. 1993; 11: 444-449
- The diagnostic applications of saliva—a review.Crit Rev Oral Biol Med. 2002; 13: 197-212
- Use of saliva-based nano-biochip tests for acute myocardial infarction at the point of care: a feasibility study.Clin Chem. 2009; 55: 1530-1538
- Salivary biomarkers of stress: cortisol and alpha-amylase.Psychoneuroendocrinology. 2009; 34: 1
- A sympathetic reflex elicited by experimental coronary occlusion.Am J Physiol. 1969; 217: 703-709
- Salivary alpha-amylase as a non-invasive biomarker for the sympathetic nervous system: current state of research.Psychoneuroendocrinology. 2009; 34: 486-496
- Universal definition of myocardial infarction.Circulation. 2007; 116: 2634-2653
- Serial plasma catecholamine response early in the course of clinical acute myocardial infarction: relationship to infarct extent and mortality.Am Heart J. 1981; 102: 24-29
- Intravascular platelet aggregation in the heart induced by stress.Circulation. 1973; 47: 353-358
- Mechanisms contributing to malignant dysrhythmias induced by ischemia in the cat.J Clin Invest. 1978; 61: 109-119
- Propranolol in the treatment of acute myocardial infarction: effect on myocardial oxygenation and hemodynamics.Circulation. 1974; 49: 1078-1087
- Effect of propranolol in myocardial infarction.Lancet. 1965; 2: 551-553
- The influence of sympathetic activity and isoprenaline on the secretion of amylase from the human parotid gland.Arch Oral Biol. 1974; 19: 747-752
- Effects of the beta-adrenoceptor antagonists atenolol and propranolol on human whole saliva flow rate and composition.Arch Oral Biol. 1992; 37: 579-584
- Salivary alpha-amylase as a measure of endogenous adrenergic activity.Clin Physiol. 1996; 16: 433-448
- Innate secretory immunity in response to laboratory stressors that evoke distinct patterns of cardiac autonomic activity.Psychosom Med. 2003; 65: 245-258
- Stress-induced changes in human salivary alpha-amylase activity–associations with adrenergic activity.Psychoneuroendocrinology. 2006; 31: 49-58
- Methodological considerations in the use of salivary alpha-amylase as a stress marker in field research.Am J Hum Biol. 2008; 20: 617-619
- Adrenergic factors in arrhythmogenesis in the ischemic and reperfused myocardium.Eur Heart J. 1983; 4: 79-90
- Anoxia-induced release of noradrenaline from the isolated perfused heart.Nature. 1965; 207: 88-89
- Influence of myocardial ischemia and infarction on autonomic innervation of heart.Circulation. 1990; 82: 1095-1105
- Incidence, significance, and management of early bradyarrhythmia complicating acute myocardial infarction.Lancet. 1968; 2: 1097-1101
- Arrhythmias in the first hours of acute myocardial infarction.Prog Cardiovasc Dis. 1981; 23: 265-278
- Sympathetic drive in anterior and inferior uncomplicated acute myocardial infarction.Circulation. 2004; 109: 2285-2289
- Performance evaluation of salivary amylase activity monitor.Biosens Bioelectron. 2004; 20: 491-497
- Determinants of salivary alpha-amylase in humans and methodological considerations.Psychoneuroendocrinology. 2009; 34: 469-485
- Determinants of the diurnal course of salivary alpha-amylase.Psychoneuroendocrinology. 2007; 32: 392-401
- The search for new cardiovascular biomarkers.Nature. 2008; 451: 949-952
Published online: November 07, 2011
Accepted: June 5, 2011
Received in revised form: April 25, 2011
Received: December 3, 2010
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.