Differentiating ischemic from non-ischemic chest pain using white blood cell-surface inflammatory and coagulation markers

Chest pain is one of the most common complaints seen in emergency departments (ED), up to 5-8 % of all ED visits. About 50-60 % of chest pain patients presenting to the ED are hospitalized. Seventy percentage of those patients not discharged from the ED are subsequently shown to not have acute cardiac disease. It has been estimated that emergency physician miss 2-6 % of acute coronary syndrome (ACS) that present to ED. While admitting a non-ACS patient is a financial burden on the medical system, releasing to home an undiagnosed ACS patient has life-threatening consequences. This study used flow cytometry to evaluate a panel of mononuclear cells, neutrophils, cytokines and fibrinolytic activation markers in patients presenting in ED with acute chest pain. The goal was to add diagnostic tools to the differentiation between true ischemic cardiac and non-ischemic chest pain in the process of triage. The study population consisted of 74 consecutive patients presenting with acute chest pain to the emergency department of Ziv Medical Center and were admitted to Intensive Cardiac Care Unit or Internal Wards of our hospital during the period September 2009 to February 2010. ACS has been clearly associated with a decrease in CD89+/CD62L+ population, an increase in percentage of cytotoxic T-cell subset, and an increase in platelet marker. Differences in thrombin receptor surface expression were also noted. The combination of multiple biomarkers may help to enhance diagnostic accuracy.