Mohamed A Tabl, Mohamed Mahrous, Reda B. Bastawesi, Amal Abou El Fadle and Omminea A. Abdullah
Ischaemia Modified Albumin as a New Biomarker in the Early Diagnosis of Acute Coronary Syndrome
Background: Early identification of acute coronary syndrome (ACS) is important. CK-MB and cardiac troponins show a delayed rise approximately 3 to 6 hours after the onset of pain. Ischaemia modified albumin (IMA) has been licensed through FDA for the early diagnosis of myocardial ischaemia. This study aimed to assess the role of IMA in the early diagnosis of ACS.
Methods: This study was conducted on 60 patients who were admitted in the Cardiac Care Unit (CCU) of Benha University Hospitals with acute chest pain less than 3 hours before admission. All patients underwent serial IMA and cardiac troponin T (cTnT) both at presentation and after 8 hours. Patients were divided into two groups according to the discharge diagnosis: non-ischaemic or ischaemic chest pain group. This classification based on criteria of pain, ECG changes, and wall motion abnormalities by echocardiography plus positive cTnT. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) for both IMA and cTnT were analyzed.
Results: Using 75 ng/dl as a cut off value for IMA and 0.04 ng/ dl for cTnT, the sensitivity and NPV of IMA to rule out ischaemia was greater as compared to that of cTnT (70.6% & 63% vs 44.1% & 42.2%). The combination between the IMA and the cTnT results improved the sensitivity and NPV up to 85.3% at presentation and up to 100% 8 hours after admission.
Conclusion: IMA is a useful marker for the early rule out of ACS. Negative IMA (<75 ng/dl) and cTnT (<0.04 ng/dl) values plus normal or non-specific ECG changes could safely rule out the ischaemic etiology of chest pain early after presentation.
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