Lipoprotein-associated phospholipase-A2 activity and its diagnostic potential in patients with acute coronary syndrome and acute ischemic stroke

Sedat Kocak; Birsen Ertekin; Abdullah Sadik Girisgin; Zerrin Defne Dundar; Mehmet Ergin; Idris Mehmetoglu; Said Bodur; Basar Cander

doi:10.1016/j.tjem.2016.10.001

Sedat Kocak¹, Birsen Ertekin², Abdullah Sadik Girisgin¹, Zerrin Defne Dundar¹, Mehmet Ergin¹ , Idris Mehmetoglu³, Said Bodur⁴, Basar Cander¹

¹Emergency Department, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
²Emergency Department, Beyhekim State Hospital, Konya, Turkey
³Biochemistry Department, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey
⁴Public Health Department, Balıkesir University Faculty of Medicine, Balıkesir, Turkey

Keywords: Lipoprotein-associated phospholipase-A2; Ischemia; Emergency medicine

Abstract

Background: The study examined the Lp-PLA2 activity at the patients presented to the emergency department with acute coronary syndrome (ACS) or acute ischemic stroke (AIS), as well as its diagnostic value.

Methods: The prospective study included consecutive male and female patients aged >18 years that presented to the our emergency department with ACS or AIS between November 2009 and January 2010. Blood samples were obtained immediately following diagnosis in the ACS and AIS groups. The diagnostic value of Lp-PLA2 was determined based on receiver operating characteristic curves, sensitivity, specificity, predictive values, likelihood ratios and accuracy rates.

Results: In all, 34 ACS and 32 AIS patients were included in the study, and the control group included 35 patients. Lp-PLA2 enzyme activity was significantly lower in the ACS and AIS groups than in the control group (26.7 ± 13.8, 31.4 ± 13.6, and 41.4 ± 8.1 nmol min−1·mL−1, respectively; p < 0.0001, p = 0.022). In the ACS group the area under the curve (AUC) was 0.825 (95%CI: 0.722–0.929), sensitivity was 71% for an optimal Lp-PLA2 cut-off value of 31.4 nmol min−1·mL−1, and specificity was 91%, whereas in the AIS group the AUC was 0.768 (95%CI: 0.652–0.884), sensitivity was 75% for an optimal Lp-PLA2 cut-off value of 38.1 nmol min−1·mL−1, and specificity was 74%.

Conclusions: Lp-PLA2 enzyme activity was significantly lower during the early stage of both ACS and AIS. The obtained statistic data suggest that low Lp-PLA2 enzyme activity can be used for diagnostic purposes.