Background Cell adhesion molecules (CAMs) play a pivotal role in the interactions between leukocytes, platelets, and vascular endothelium. Soluble CAMs (sCAMs) are shed from cell surfaces and reflect cellular activation. Elevated levels of sCAMs have been reported in the acute coronary syndromes. We hypothesized, therefore, that sCAMs might prove of prognostic value in patients with acute chest pain presumed to be the result of myocardial ischemia. Methods One hundred twenty-six consecutive patients with chest pain, thought clinically to represent myocardial ischemia, were studied prospectively. Soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), E-selectin (sE-selectin) and P-selectin (sP-selectin) levels were assayed at presentation, as were cardiac troponin I (cTnI) and creatine kinase-MB_mass (CK-MB_mass). The primary study end point was the occurrence of a serious cardiac event (SCE) during the index admission or the subsequent 3 months. Results sP-selectin and cTnI levels were significantly higher among patients who had an early SCE (P = .006 and P < .001, respectively). Both remained independently predictive (P < .001) in a multivariate regression equation. The other independent predictor was a history of vascular disease (P < .05). No other markers were significant predictors of early outcome. Conclusion Elevated sP-selectin levels, but not those of other sCAMs, are predictors of early adverse events in patients with chest pain presumed caused by myocardial ischemia. Their utility in predicting the outcome of individual patients is, however, limited. (Am Heart J 2002;143:235-41.)