The diagnosis of myocardial ischemia in patients with acute chest pain at rest but non-diagnostic electrocardiograms (ECG)-is problematic. Ischemia Modified Albumin (IMA) is a new biochemical marker of ischemia, whi...The diagnosis of myocardial ischemia in patients with acute chest pain at rest but non-diagnostic electrocardiograms (ECG)-is problematic. Ischemia Modified Albumin (IMA) is a new biochemical marker of ischemia, which may be useful to characterise acute coronary syndrome (ACS) patients. We studied 131 patients (mean age 58.5 years; 95 male) presenting to the emergency department with symptoms suggestive of ACS but with normal or non-diagnostic ECGs. Cardiac troponin T (cTnT) and IMA were measured within 3 h of last chest pain episode. Based on hospital diagnostic test results, patients were classified as having ACS or non-ischemic chest pain(NICP), by two independent cardiologists unaware of IMA results. Mean IMA levels(U/ml)were higher in patientswithACS (98.3±11)-compared to patients with NICP (85.5±15); p< 0.0001. IMA levels >93.5 U/ml demonstrated a sensitivity and specificity of 75%for the diagnosis of ACS; area under the receiver operator characteristic curve 0.78 (95%CI: 0.70-0.85). If we applied the manufacturer cutoff point of 85 U/ml, the sensitivity of IMA increased to 90.6%with a specificity of 49.3%(negative predictive value=84.6%). In combination with cTnT (6-12 h) (> 0.05 ng/ml), the sensitivity increased to 92.2%. After multivariate analysis, IMA levels >85 U/ml (odds ratio=14.6[95%CI 4.4-48.4]; p < 0.0001), age and prior myocardial infarctionwere independent predictors ofACS. IMA may be a useful biomarker for the identification of ACS in patients presenting with typical acute chest pain but normal or non-diagnostic ECGs.展开更多
文摘The diagnosis of myocardial ischemia in patients with acute chest pain at rest but non-diagnostic electrocardiograms (ECG)-is problematic. Ischemia Modified Albumin (IMA) is a new biochemical marker of ischemia, which may be useful to characterise acute coronary syndrome (ACS) patients. We studied 131 patients (mean age 58.5 years; 95 male) presenting to the emergency department with symptoms suggestive of ACS but with normal or non-diagnostic ECGs. Cardiac troponin T (cTnT) and IMA were measured within 3 h of last chest pain episode. Based on hospital diagnostic test results, patients were classified as having ACS or non-ischemic chest pain(NICP), by two independent cardiologists unaware of IMA results. Mean IMA levels(U/ml)were higher in patientswithACS (98.3±11)-compared to patients with NICP (85.5±15); p< 0.0001. IMA levels >93.5 U/ml demonstrated a sensitivity and specificity of 75%for the diagnosis of ACS; area under the receiver operator characteristic curve 0.78 (95%CI: 0.70-0.85). If we applied the manufacturer cutoff point of 85 U/ml, the sensitivity of IMA increased to 90.6%with a specificity of 49.3%(negative predictive value=84.6%). In combination with cTnT (6-12 h) (> 0.05 ng/ml), the sensitivity increased to 92.2%. After multivariate analysis, IMA levels >85 U/ml (odds ratio=14.6[95%CI 4.4-48.4]; p < 0.0001), age and prior myocardial infarctionwere independent predictors ofACS. IMA may be a useful biomarker for the identification of ACS in patients presenting with typical acute chest pain but normal or non-diagnostic ECGs.
