Abstract
Background
To rule out acute myocardial infarction (AMI) in chest pain patients constitutes a
diagnostic challenge to emergency department (ED) physicians.
Study Objectives
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.
Methods
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.
Results
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%).
Conclusions
High initial sAA activity is an independent predictor of AMI in patients presenting
to the ED with chest pain.
Keywords
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Article info
Publication history
Published online: November 07, 2011
Accepted:
June 5,
2011
Received in revised form:
April 25,
2011
Received:
December 3,
2010
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
