Utility of serum ischemia modified albumin in the early diagnosis of acute coronary syndrome

Abstract

Utility of serum ischemia modified albumin in the early diagnosis of acute coronary syndromeContext: Coronary artery disease (CAD) is the leading cause of death. Early detection of myocardial ischemia can decrease morbidity and mortality due to CAD. Ischemia modified albumin (IMA) is a newer biomarker for early detection of myocardial ischemia in patients of acute coronary syndrome (ACS) as compared to cardiac troponin T (cTnT). Aims: The aim of this study was to test the utility of "IMA," a new biomarker of myocardial ischemia, in the early diagnosis of ACS. Settings and Design: The cross-sectional study group consisted of 101 patients between the age group of 27 and 85 years having ACS and 100 control from a healthy population. Materials and Methods: Blood was collected from all the enrolled patients immediately after admission, and samples were analyzed for cTnT on the fully automated analyzer and IMA on a spectrophotometer. Statistical Analysis Used: Statistical analysis was carried out by calculation of the area under a curve using receiver operating characteristics (ROC) curve analysis for the IMA test in the 101 patients included in the study population. Results: ROC curve area for IMA was 0.89 (95% confidence interval 0.81-0.94). At the cut-off 95 U/ml, sensitivity, and specificity were 85% and 82% and positive predictive value and negative predictive value (NPV) were 88% and 78%, respectively. Conclusions: IMA is a useful ischemic marker for diagnosis of myocardial ischemia due to high sensitivity, and it also facilitates to rule out myocardial ischemia due to high NPV. Key words: Cardiac troponin T, coronary artery disease, myocardial ischemiaOriginal Article INTRODUCTIONAcute coronary syndromes (ACSs) is a spectrum of disease including unstable angina, associated with reversible myocardial cell injury, Q-wave and non-Q-wave acute myocardial infarction (AMI), non-ST-segment elevation MI and ST-segment elevation MI with large areas of necrosis.[1] Myocardial ischemia occurs either due to a lack of blood flow resulting in a shortage of oxygen and accumulation of waste products in the ischemic tissue. This results in a number of biochemical changes in the cells and if continued, leads to irreversible damage and necrosis.[2] ACS is becoming more common in the developing world such that in India, cardiovascular disease is the leading cause of death in India. [3] Every patient with acute chest pain presenting to Emergency Department should be identified and confirmed for ACS for accurate medical management.[4] Electrocardiography (ECG), troponin and creatine kinase-MB are conventional markers for diagnosis of ACS. These blood markers are extremely sensitive and specific for the identification of patients with myocardial necrosis, but their ability to identify patients with myocardial ischemia remains limited. ECG is rarely abnormal following transient myocardial ischemia, and the ECG at presentation is normal in approximately half of the patients with ACSs.[5] These highly specific markers might give negativ...