Key result
Higher serum plasminogen linked to ~4% higher ACS risk in troponin-negative chest pain.
Why the study?
Early diagnosis of ACS in chest pain patients with normal high-sensitivity troponin remains challenging, and the diagnostic performance of plasminogen and other prothrombotic biomarkers in this setting required evaluation.
Does serum plasminogen improve early detection of in-hospital non-ST-elevation acute coronary syndrome in patients presenting with chest pain and initially normal high-sensitivity troponin T?
Observational (n=156)
Researchers blinded to thrombosis/thrombolysis marker results at the time of care
No
Does serum plasminogen improve early detection of in-hospital non-ST-elevation acute coronary syndrome in patients presenting with chest pain and initially normal high-sensitivity troponin T?
In chest pain patients with initially normal high-sensitivity troponin T, serum plasminogen demonstrated moderate diagnostic discrimination (AUC 0.74) and was independently associated with in-hospital non-ST-elevation ACS, suggesting potential utility for early risk stratification.
May support plasminogen testing for early ACS stratification in troponin-negative chest pain; leaves open prospective validation before clinical adoption.
Background Early diagnosis of acute coronary syndrome (ACS) in patients presenting with chest pain and normal high-sensitivity troponin remains challenging. Prothrombotic biomarkers may provide complementary diagnostic information in this setting. Objective To evaluate the diagnostic performance of plasminogen and other coagulation biomarkers for detecting ACS in patients admitted to a ER chest pain unit with initially normal high-sensitivity troponin T. Methods We conducted a prospective observational study including consecutive patients admitted to an emergency department chest pain protocol. High-sensitivity troponin T was measured at 0 and 3 hours. At admission, plasminogen, fibrinogen, fibrinogen degradation products, factor VIIIc, von Willebrand factor, and D-dimer were assessed. The serum samples collected and stored at -70°C and subsequently analyzed using IL coagulation systems and an ACL TOP 300 instrument VM. High-sensitivity troponin T was determined using a ROCHE ELECSYS analyzer. At the time of care, the researchers were blinded to the results of the thrombosis/thrombolysis markers.Patients receiving anticoagulation or heparin before sampling were excluded. The primary endpoint was in-hospital diagnosis of non-ST-elevation ACS. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed in all patients. For data comparison, statistics and ROC curve analysis we used a SPSS version 26 software. Results One hundred fifty six patients were included (mean age 62±12 years, 42% women); 32% were diagnosed with ACS. Using the best cut-off value (66 % activity), serum plasminogen showed a LR+ of 1.70 and a LR - of 0.53 for ACS diagnosis. In multivariable analysis, plasminogen was independently associated with ACS (OR 1.04 per each unit increase; 95% CI 1.00–1.08; p=0.040), Plasminogen showed the best diagnostic discrimination (AUC 0.74; 95% CI 0.55–0.93) compared with fibrinogen 0.59 (95% CI: 0.39–0.79) , factor VIIIc 0.49 (95% CI: 0.22–0.76), von Willebrand factor 0.52 (95% CI: 0.28–0.75) , and fibrinogen degradation products 0.46 (95% CI: 0.25–0.67), multiple paired De Long Test comparisons p < 0.05. .Serum plasminogen remained independently associated with ACS diagnosis after adjustment for age, sex, and ECG changes: OR 2.6 (IC 95% 0.849-8,406), p = 0.033 . Conclusion Our preliminary data demostrated that in patients presenting with suspected acute coronary syndrome and normal high-sensitivity troponin, serum plasminogen may be a useful tool for early risk stratification."
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Higa et al. (2026) conducted an observational in Chest pain with initially normal high-sensitivity troponin T (suspected acute coronary syndrome) (n=156). Serum plasminogen vs. Fibrinogen, factor VIIIc, von Willebrand factor, fibrinogen degradation products, and D-dimer was evaluated on In-hospital diagnosis of non-ST-elevation acute coronary syndrome (ACS) (OR 1.04, 95% CI 1.00-1.08, p=0.040). Serum plasminogen was independently associated with ACS in hs-troponin T-negative chest pain patients (OR 1.04; 95% CI 1.00–1.08; p=0.040) with superior discrimination (AUC 0.74; p<0.05).
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