Studies on P-selectin, malondialdhyde-modified low-density lipoprotein, C-reactive protein, B-type natriuretic peptide, and pregnancy-associated plasma protein A (PAPP-A) are just beginning to appear (Tables 11 and 12). There is only one ED study of P-selectin that reported low sensitivity and low specificity for AMI. In the future, tests for neurohormonal activation (B-type natriuretic peptide) and inflammation (C-reactive protein, PAPP-A) may augment our ability to identify patients with acute cardiac ischemia who are at risk for adverse events. The use of these markers could potentially augment our ability to reserve the most expensive and aggressive therapies for patients who have the highest risk.
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