Utility of Some Fibrinolytic System Parameters for Differential Diagnosis Between Ischemic and Non-Cardiogenic Chest Pain

The aim of the study is to assess the diagnostic accuracy of some fibrinolytic parameters in the differential diagnosis between patients with unstable angina (UA) and musculoskeletal disorders (MSD). Methods. This cross-sectional study included 119 patients with chest pain (CP) and provisional diagnosis “UA”. After a full set of diagnostic procedures, authors formed 4 groups: patients with ischemic and non-cardiogenic CP without coronary artery disease (CAD) history ((1), (2)) or with CAD history ((3), (4)). Authors analyzed blood plasma tissue plasminogen activator (tPA) and plasminogen activator inhibitor type 1 (PAI-1) concentrations, tPA/PAI-1 and PAI-1/tPA ratios. Findings. Binary logistic models were assessed, receiver operating characteristic curves, calculated sensitivity (Se), specificity (Sp), and positive likelihood ratio (LR+) of each indicator. No diagnostic utility of tPA concentration alone was revealed (P=0.68). PAI-1 concentration and PAI-1/tPA ratio demonstrated a moderate increase (by 28% and 26%) in the probability of UA (LR+ 4.66 (2.57, 8.45) and 3.87 (2.29, 6.55), Se 87.3% and 88.7%, Sp 81.2% and 77.1% at cut-off point 0.343 rel.units/ml and 1.775, respectively), while tPA/PAI-1 raised the probability of MSD by 41% (LR+ 6.47 (3.29, 13.00), Se 72.9%, Sp 88.7% at cut-off point 0.584). Conclusions. PAI-1 concentration alone and tPA/PAI-1 ratio, but not tPA alone have demonstrated promising results for differential diagnostic between ischemic and non-cardiogenic CP.