Korean J Med.  2006 Dec;71(6):620-626.

The usefulness of ischemia modified albumin as an early ischemic marker to detect coronary artery disease in patients with chest pain presenting to the emergency department

• Jang EC
• Jeon HK
• Kim SH
• Shin DI
• Jeong HB
• Shin JA
• Shin WS
• Jang KY
• Kim YS
• Lee HK
• Choi KH
• Youn HJ
• Chung WS
• Kim JH
• Hong SJ
• Seung KB

Abstract

BACKGROUND: A diagnosis of coronary artery disease (CAD) in the early phase of acute chest pain is often difficult in an emergency department (ED) due to the lower sensitive ECG and delayed expression of the cardiac necrosis markers. Ischemia modified albumin (IMA) has recently been reported to be an early sensitive biochemical marker of ischemia. The aim of this study was to evaluate the diagnostic value of IMA in patients with suspected CAD and less sensitive ECG/delayed cardiac necrosis markers.
METHODS
100 consecutive patients (mean age: 5413 years, male: 66%) presenting to the ED with suspected CAD and chest pain within 6 hours of chest pain were enrolled in this study. An ECG check and blood sampling for IMA and CK-MB, cardiac troponin-T (TnT) were done within 1 hour at the ED. The diagnosis of CAD was based upon the clinical findings, results of serial ECG/TnT and coronary angiography. The ideal cutoff value of IMA for CAD was calculated by the Receiver Operator Characteristic (ROC) curve analysis.
RESULTS
CAD including acute coronary syndrome was diagnosed in 69/100 (69%). The optimum diagnostic cutoff point for the IMA levels in these study populations was found by ROC analysis to be 99.5 U/mL. The ROC curve area for the IMA test was 0.901 (95% confidential interval, 0.840-0.961, p=0.001). The IMA levels >99.5 U/mL demonstrated a sensitivity of 86%, specificity of 81%, positive predictive value of 90% and negative predictive value of 74% for the diagnosis of CAD. The combination of IMA-ECG-CKMB/TnT increased the sensitivity for detecting ischemia to 94%, with a negative predictive value of 85%. IMA is a highly sensitive with a high negative predictive value, and might improve the utility of standard biomarkers for CAD.
CONCLUSIONS
IMA might be a useful ischemic marker of coronary artery disease in patients presenting within 6 hours after the onset of chest pain.

Keyword

Acute chest pain; Ischemia modified albumin; Coronary artery disease

MeSH Terms

Acute Coronary Syndrome
Biomarkers
Chest Pain*
Coronary Angiography
Coronary Artery Disease*
Coronary Vessels*
Diagnosis
Electrocardiography
Emergencies*
Emergency Service, Hospital*
Humans
Ischemia*
Male
Necrosis
ROC Curve
Sensitivity and Specificity
Thorax*
Troponin T
Troponin T