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

The study aimed to assess the diagnostic accuracy of some fibrinolytic parameters in the differential diagnosis between patients with unstable angina and musculoskeletal disorders.

This cross-sectional study included 119 patients with chest pain, and the provisional diagnosis “UA” was conducted in in 2021 in Bogomolets National Medical University. After a full set of diagnostic procedures, the authors formed four groups: patients with ischemic and non-cardiogenic chest pain without coronary artery disease history (1 & 2) or coronary artery disease history (3 & 4). Blood plasma tissue plasminogen activator and plasminogen activator inhibitor type 1 concentrations, tissue plasminogen activator/plasminogen activator inhibitor type 1, and plasminogen activator inhibitor type 1/tissue plasminogen activator ratios were analyzed.

Binary logistic models were assessed, receiver operating characteristic curves, calculated sensitivity, specificity, and positive likelihood ratio of each indicator. No diagnostic utility of tissue plasminogen activator concentration alone was revealed (p=0.68). Plasminogen activator inhibitor type 1 concentration and plasminogen activator inhibitor type 1/tissue plasminogen activator ratio demonstrated a moderate increase (by 28% and 26%) in the probability of UA (positive likelihood ratio= 4.66 (2.57, 8.45) and 3.87 (2.29, 6.55), sensitivity 87.3% and 88.7%, specificity 81.2% and 77.1% at cut-off point 0.343rel.units/ml and 1.775, respectively), while tissue plasminogen activator/plasminogen activator inhibitor type 1 raised the probability of MSD by 41% (positive likelihood ratio= 6.47 (3.29, 13.00), sensitivity 72.9%, specificity 88.7% at cut-off point 0.584).

PAI-1 concentration alone and tissue plasminogen activator /PAI-1 ratio but not tissue plasminogen activator alone have demonstrated promising results for differential diagnostic between ischemic and non-cardiogenic chest pain.