Role of “Ischemia Modified Albumin”, a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes

• Published in: Emergency medicine journal : EMJ Vol. 21; no. 1; pp. 29 - 34
• Main Authors: Sinha, M K, Roy, D, Gaze, D C, Collinson, P O, Kaski, J-C
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01-01-2004; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Group
• Subjects: ACS; Acute coronary syndromes; acute myocardial infarction; Adult; Aged; Aged, 80 and over; AMI; Biomarkers - blood; cardiac troponins; Cardiovascular disease; Chest Pain - etiology; Coronary Angiography; CTtn; Electrocardiography; Emergencies; emergency department; Female; Gangrene; Heart attacks; Humans; IHD; IMA; ischaemic heart disease; Ischemia; ischemia modified albumin; Male; Middle Aged; Myocardial Ischemia - blood; Myocardial Ischemia - complications; Myocardial Ischemia - diagnosis; negative predictive value; NICP; non-ischaemic chest pain; non-ST segment elevation infarction; NPV; NSTEMI; Original; Pain; positive predictive value; PPV; Prospective Studies; Sensitivity and Specificity; Serum Albumin - analysis; ST segment elevation myocardial infarction; Statistics, Nonparametric; STEMI; Troponin T - analysis; unstable angina
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emj.2003.006007

Background: Diagnosis of cardiac ischaemia in patients attending emergency departments (ED) with symptoms of acute coronary syndromes is often difficult. Cardiac troponin (cTn) is sensitive and specific for the detection of myocardial damage but may not rise during reversible myocardial ischaemia. Ischemia Modified Albumin (IMA) has recently been shown to be a sensitive and early biochemical marker of ischaemia. Methods and Results: This study evaluated IMA in conjunction with ECG and cTn in 208 patients presenting to the ED within three hours of acute chest pain. At presentation, a 12-lead ECG was recorded and blood taken for IMA and cardiac troponin T (cTnT). Patients underwent standardised triage, diagnostic procedures, and treatment. Results of IMA, ECG, and cTnT, alone and in combination, were correlated with final diagnoses of non-ischaemic chest pain, unstable angina, ST segment elevation, and non-ST segment elevation myocardial infarction. In the whole patient group, sensitivity of IMA at presentation for an ischaemic origin of chest pain was 82%, compared with 45% of ECG and 20% of cTnT. IMA used together with cTnT or ECG, had a sensitivity of 90% and 92%, respectively. All three tests combined identified 95% of patients whose chest pain was attributable to ischaemic heart disease. In patients with unstable angina, sensitivity of IMA used alone was equivalent to that of IMA and ECG combined. Conclusions: IMA is highly sensitive for the diagnosis of myocardial ischaemia in patients presenting with symptoms of acute chest pain.