Serum Concentrations of Ischaemia-Modified Albumin in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Abstract

The identification of novel circulating biomarkers of acute coronary syndrome (ACS) may improve diagnosis and management. We conducted a systematic review and meta-analysis of ischaemia-modified albumin (IMA), an emerging biomarker of ischaemia and oxidative stress, in ACS. We searched PubMed, Web of Science, and Scopus from inception to March 2022, and assessed the risk of bias and certainty of evidence with the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 18 studies (1654 ACS patients and 1023 healthy controls), IMA concentrations were significantly higher in ACS (standard mean difference, SMD = 2.38, 95% CI 1.88 to 2.88; p < 0.001; low certainty of evidence). The effect size was not associated with pre-defined study or patient characteristics, barring the country where the study was conducted. There were no significant differences in effect size between acute myocardial infarction (MI) and unstable angina (UA), and between ST-elevation (STEMI) and non-ST-elevation MI (NSTEMI). However, the effect size was progressively larger in UA (SMD = 1.63), NSTEMI (SMD = 1.91), and STEMI (3.26). Our meta-analysis suggests that IMA might be useful to diagnose ACS. Further studies are warranted to compare the diagnostic performance of IMA vs. established markers, e.g., troponin, and to determine its potential utility in discriminating between UA, NSTEMI, and STEMI (PROSPERO registration number: CRD42021324603).

Ischemia‐modified albumin in rheumatic diseases: A systematic review and meta‐analysis

“…38 The pathophysiological role of IMA has been primarily investigated in cerebrovascular disease and acute coronary syndrome. [41][42][43][44][45][46] However, significant alterations in IMA concentrations have also been reported in congestive heart failure, 47 neurodegenerative disorders, 48 pregnancy disorders, 92 and cancer. 52 These observations support the proposition that the increase in IMA concentrations observed in a wide range of conditions without a clinically overt ischemic process is primarily due to a pro-oxidant state and, potentially, acidosis, rather than ischemia.…”

“…The pathophysiological role of IMA has been primarily investigated in cerebrovascular disease and acute coronary syndrome 41‐46 . However, significant alterations in IMA concentrations have also been reported in congestive heart failure, 47 neurodegenerative disorders, 48 pregnancy disorders, 92 and cancer 52 .…”

“… 38 Such chemical modifications can also be triggered by oxidative stress and acidosis. 38 Alterations in the concentrations of IMA have been investigated in physiological processes, for example, physical exercise and pregnancy, 39 , 40 as well as cerebrovascular disease, ischemic heart disease, and heart failure, 41 , 42 , 43 , 44 , 45 , 46 , 47 neurological disorders, 48 , 49 diabetes mellitus, 50 and cancer. 51 , 52 Given that the formation of IMA reflects, in addition to ischemia, the presence of oxidative stress and acidosis, commonly observed in patients with RDs, 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 we assessed the potential role of IMA as a biomarker by conducting a systematic review and meta‐analysis of circulating IMA concentrations in RD patients and healthy controls.…”

Association between ischemia-modified albumin (IMA) and peripheral endothelial dysfunction in rheumatoid arthritis patients

“…Ischemia modified albumin (IMA), resulting from chemical changes of albumin during ischemia, has been suggested as a candidate biomarker for acute coronary syndrome 16 . Several studies have also reported increased serum IMA concentrations in non-cardiac diseases (e.g., sepsis, intestinal ischemia, acute pulmonary embolism) as a result of a common background of acute and chronic inflammatory state, increased oxidative stress, and reactive oxygen species formation 17 .…”

Association of Ischemia-Modified Albumin (IMA) in Saliva, Serum, and Urine with Diagnosis of Chronic Kidney Disease (CKD) in Children: A Case-Control Study

“…In addition to quantitative changes, albumin can also undergo structural modifications during oxidative stress, which leads to the synthesis of ischemia-modified albumin (IMA) [ 14 ]. Research has shown that IMA is a reliable early biomarker of ischemia (without myocardial necrosis), and its concentration is determined by kidney function in patients undergoing dialysis [ 15 , 16 ]. The clinical usefulness of IMA has also been postulated in other conditions involving oxidative stress and ischemia, such as diabetes, neurological disorders, pregnancy complications, hypothyroidism, and hyperthyroidism [ 15 ].…”