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Clinical Significance of Ischemia Modified Albumin in Early Diagnosis of Acute Coronary Syndrome

Author: LiShanShan
Tutor: ZhangChaoMing
School: Chengdu University of Traditional Chinese Medicine
Course: Chinese and Western medicine combined with the basis
Keywords: Acute coronary syndrome Ischemia modified albumin Albumin-cobalt binding test Traditional tools in ACS The diagnostic values NT-proBNP
CLC: R541.4
Type: Master's thesis
Year: 2011
Downloads: 43
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Abstract

Objective:To evaluate the value of early diagnosis of ischemia modified albumin (IMA) in acute coronary syndrome.Methods:92 patients suspected acute coronary syndrome were selected into the study, who were diagnosed within 3 hours after onset of chest pain, including 60 cases diagnosed with ACS and 32 cases with NICP. According to diagnostic standard,20 cases of 60 patients with ACS were diagnosed with unstable angina (UA),18 cases with ST segment elevation myocardial infarction(STEMI)and 22 cases with non-ST segment elevation myocardial infarction(NSTEMI). Serum IMA was measured by albumin cobalt binding (ACB) test right after admission as was in 30 healthy controls. The ACB values were compared between patients with ACS and healthy controls, and it was also compared between patients with ACS and patients with NICP. And then the ACB values were compared among three groups of ACS. Receiver operator characteristic curve (ROC curve) analysis was used to determine the optimal cutoff of identifying ACS from healthy controls and ACS from patients with NICP. And IMA was compared the diagnostic values with traditional tools in ACS. Serum NT-proBNP was compared between patients with ACS and patients with NICP.The areas under receiver operating characteristic curve of IMA and NT-proBNP were compared to evaluated accuracy of diagnosing ACS, and the correlation was analysed between these two biomarkers.Results:1 ACB values of ACS was significantly less than that of healthy controls and the NICP group, P<0.01. There was not an obvious distinction of ACB values among three groups of ACS, P>0.05.2 Receiver operator characteristic curve (ROC curve) analysis was used to determine the optimal cutoff of identifying ACS from healthy controls.At a cutoff=80U/ml,the sensitivity and specificity of this cutoff threshold to identify ACS were 86% and 94% respectively and the area under ROC curve (AUC) was 0.944. From ROC curve analysis used to identify ACS from NICP, at a cutoff=77U/ml, the sensitivity and specificity of this cutoff threshold to identify ACS were 8o% and 84% respectively and the area under ROC curve (AUC) was 0.886.3 The sensitivity and negative predictive value of IMA(80% and 69%) was significantly higher than that of Mb(20% and 34%)、cTnI(18% and 39%)、NT-proBNP(42% and 43%) and ECG (47% and 47%).But the specificity of IMA (84%) was significantly lower than that of cTnI(97%)and ECG(90%).And the positive predictive value of IMA(90%) was lower than that of cTnI(92%), and equivalent to that of ECG (90%).4 There was an obvious distinction between NT-proBNP values of the ACS group and that of the NICP group (P<0.01). The correlation coefficient is -0.495 between the ACB values and NT-proBNP values in the ACS group (P<0.01). The decrease of ACB values means the increase of serum IMA levels. So there is a certain extent statistical relativity between IMA and NT-proBNP. The areas under receiver operating characteristic curve to identify ACS from NICP of IMA was bigger than that of NT-proBNP(P<0.05).It indicated the accuracy to diagnose ACS of IMA was higher than that of NT-proBNP.Conclusions:1IMA can be used in the early diagnosis of patients suspected ACS, and it can significantly enhance the diagnostic sensitivity and negative predictive value of ACS.2 Serum IMA assessment is valuable for early diagnosis of cardiac ischemia, but it is not a good marker for early differentiation of myocardial ischemia from acute myocardial infarction.3 The accuracy to diagnose ACS of IMA is higher than that of NT-proBNP.

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