Fibulin‑1 and fibulin‑5 as rule‑out tests for non-ST‑elevation myocardial infarction in the emergency setting.

BACKGROUND:Fibulin‑1 and fibulin‑5 are extracellular glycoproteins from the fibulin family. Both are expressed in the vessel wall and protect against vascular damage. AIMS:We aimed to investigate whether fibulin‑1 and ‑5 may be used to exclude non-ST‑segment elevation myocardial infarction (NSTEMI) in the emergency setting. METHODS:The study included 48 patients in the NSTEMI group and 42 controls who presented with chest pain of noncardiac origin as confirmed by a comprehensive evaluation including coronary angiography. Blood samples for fibulin‑1, fibulin‑5, and troponin I measurements were drawn on admission to the emergency department. RESULTS:Demographic characteristics were similar in patients with NSTEMI and controls. The median levels of both glycoproteins were lower in patients with NSTEMI as compared with controls: fibulin‑1, 96.9 μg/ml (interquartile range [IQR], 20-503 μg/ml) vs 111.5 (IQR, 71-457 μg/ml), P = 0.01, and fibulin‑5, 38 ng/ml (IQR, 15-509 ng/ml vs 57 ng/ml (IQR, 26-631 ng/ml), P <0.001. The receiver operating characteristic curve analysis revealed the cutoff value of 105.6 μg/ml for fibulin‑1 and of 49.4 ng/ml for fibulin‑5 to exclude NSTEMI on admission. CONCLUSIONS:The present study demonstrated that fibulin‑1 and -5 measurements might be used to exclude NSTEMI in patients admitted to the emergency department with acute chest pain.

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