Evaluation on Ischemia Modified Albumin in the Early Diagnosis of Non-St-Segment Elevation Acute Coronary Syndromes_Chinese Journal of Evidence-Based Medicine

Authors：

YU Tao ¹ ,  ZHOU Changyong ² , JIA Xiuling ²

1. Medical College Qingdao University, Qingdao 266000, China;2. Emergency Department, the Affiliated Hospital of Medical College Qingdao University, Qingdao 266000, China;

Corresponding author：

ZHOU Changyong, Email: 31664294@qq.com

Keywords：

Ischemia modified albumin; Non–ST-segment elevation acute coronary syndrome; Early diagnosis

DOI：

10.7507/1672-2531.20110211

Video：

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Objective 　To evaluate the early diagnostic value of ischemia modified albumin (IMA) for non-ST-segment elevation acute coronary syndromes (NSTEACS).
Methods　 The study group consisted of 177 patients with suspected NSTEACS whose blood was collected within six hours after the onset of chest pain to determine cardiac troponin I (cTnI), and IMA was determined through the albumin cobalt binding (ACB) test. After standardized diagnosis and treatment and GRACE risk score, the patients then were divided into three groups according to the final diagnosis: the NSTEMI (non-ST-segment elevation myocardial infarction) group (n=34), the UA (unstable angina pectoris) group (n=56) and the NICP (non-ischemia chest pain) group (n=87). Meanwhile, 58 people taking the routine examination in the same hospital at that time were randomly selected as the control group. With the results of IMA, ROC curve analysis was used to determine the optimal cutoff of this assay for identifying patients with NSTEACS from those with NICP. Results of IMA, ECG and cTnI were correlated with final diagnosis, and their diagnostic sensitivity and specificity were evaluated for NSTEACS.
Results 　The IMA concentration in the serum showed no significant difference between the NSTEMI group and the UA group, whereas there were significant differences between the former two groups and the NICP group. The sensitivity and specificity at a cutoff point 67.49 U/mL were 91.1% and 86.2%, respectively when the ROC curve area was 0.950. The correlation between the IMA concentration and GRACE risk score was negative.
Conclusion 　IMA is an early sensitive indicator for NSTEACS and a useful predictor of prognosis.

Citation： YU Tao,ZHOU Changyong,JIA Xiuling. Evaluation on Ischemia Modified Albumin in the Early Diagnosis of Non-St-Segment Elevation Acute Coronary Syndromes. Chinese Journal of Evidence-Based Medicine, 2011, 11(11): 1251-1254. doi: 10.7507/1672-2531.20110211 Copy

1.	1 [No authors listed]. Management of unstable angina. Guidelines--2000. The National Heart Foundation of Australia, The Cardiac Society of Australia and New Zealand. Med J Aust , 2000, 173 Suppl: S65-88.
2.	2 Roger VL, Killian JM, Weston SA, et al . Redefinition of myocardial infarction: prospective evaluation in the community. Circulation , 2006, 114(8): 790-797.
3.	3 Hamm CW, Goldmann BU, Heeschen C, et al . Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med , 1997, 337(23): 1648-1653.
4.	4 Figiel, Kasprzak JD, Peruga J, et al . Heart-type fatty acid binding protein — a reliable marker of myocardial necrosis in a heterogeneous group of patients with acute coronary syndrome without persistent ST elevation. Kardiol Pol , 2008, 66(3): 253-258.
5.	6 Eagle KA, Lim MJ, Dabbous OH, et al . A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA , 2004, 291(22): 2727-2733.
6.	7 Roy D, Quiles J, Aldama G, et al . Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T. Int J Cardiol , 2004, 97(2): 297-301.
7.	8 Peacock F, Morris DL, Anwaruddin S, et al . Meta-analysis of ischemiamodified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J , 2006, 152(2): 253-262.
8.	9 Bar-Or D, Lau E, Winkle JV. A novel assay for cobalt-albumin binding and its potential as a maker for myocardial ischemia pre-liminary report. J Emerg Med , 2000, 19(4): 311-315.
9.	10 Sinha MK, Gaze DC, Tippins IR, et al . Ischemia modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation , 2003, 107(19): 2403-2405.
10.	11 de Filippi C, Yoon S, Ro A. Early detection of myocardial ischemia by a novel blood based biomarker: the kinetics of ischemia modified albumin. J Am Coll Cardiol , 2003, 41: 6(suppl. A): 340A.
11.	12 Roy D, Quiles J, Aldama G, Sinha M, et al . Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiaograms and negative cardiac troponin T. Int J Cardiol , 2004, 97(2): 297-301.
12.	13 Christeson RH, Duh SH, et al . Characteristics of an albumin cobalt binding test for assessment of acute coronary syndrome patients: a multicenter study. Clin Chem , 2001, 47(3): 464-470.
13.	14 Peacock F, Morris DL, Anwaruddin S, et al . Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J , 2006, 152(2): 253-262.
14.	15 Consuegra-Sanchez L, Bouzas-Mosguera A, Sinha MK, et al . Ischemia modified albumin predicts short-term outcome and 1-year mortality in patients attending the emergency department for acute ischemic chest pain. Heart Vessels , 2008; 23(3): 174-180.
15.	16 Worster A, Devereaux PJ, Heels-Ausdell D, et al . Capability of ischemia-modified albumin to predict serious cardiac outcomes in the short term among patients with potential acute coronary syndrome. CMAJ , 2005, 172(13): 1685-1690.
16.	李丽, 高大胜. 缺血修饰白蛋白在冠心病临床应用中的研究进展. 中国急救医学, 2008, 28(8): 745-748.

1. 1 [No authors listed]. Management of unstable angina. Guidelines--2000. The National Heart Foundation of Australia, The Cardiac Society of Australia and New Zealand. Med J Aust , 2000, 173 Suppl: S65-88.
2. 2 Roger VL, Killian JM, Weston SA, et al . Redefinition of myocardial infarction: prospective evaluation in the community. Circulation , 2006, 114(8): 790-797.
3. 3 Hamm CW, Goldmann BU, Heeschen C, et al . Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med , 1997, 337(23): 1648-1653.
4. 4 Figiel, Kasprzak JD, Peruga J, et al . Heart-type fatty acid binding protein — a reliable marker of myocardial necrosis in a heterogeneous group of patients with acute coronary syndrome without persistent ST elevation. Kardiol Pol , 2008, 66(3): 253-258.
5. 6 Eagle KA, Lim MJ, Dabbous OH, et al . A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA , 2004, 291(22): 2727-2733.
6. 7 Roy D, Quiles J, Aldama G, et al . Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T. Int J Cardiol , 2004, 97(2): 297-301.
7. 8 Peacock F, Morris DL, Anwaruddin S, et al . Meta-analysis of ischemiamodified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J , 2006, 152(2): 253-262.
8. 9 Bar-Or D, Lau E, Winkle JV. A novel assay for cobalt-albumin binding and its potential as a maker for myocardial ischemia pre-liminary report. J Emerg Med , 2000, 19(4): 311-315.
9. 10 Sinha MK, Gaze DC, Tippins IR, et al . Ischemia modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation , 2003, 107(19): 2403-2405.
10. 11 de Filippi C, Yoon S, Ro A. Early detection of myocardial ischemia by a novel blood based biomarker: the kinetics of ischemia modified albumin. J Am Coll Cardiol , 2003, 41: 6(suppl. A): 340A.
11. 12 Roy D, Quiles J, Aldama G, Sinha M, et al . Ischemia modified albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiaograms and negative cardiac troponin T. Int J Cardiol , 2004, 97(2): 297-301.
12. 13 Christeson RH, Duh SH, et al . Characteristics of an albumin cobalt binding test for assessment of acute coronary syndrome patients: a multicenter study. Clin Chem , 2001, 47(3): 464-470.
13. 14 Peacock F, Morris DL, Anwaruddin S, et al . Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J , 2006, 152(2): 253-262.
14. 15 Consuegra-Sanchez L, Bouzas-Mosguera A, Sinha MK, et al . Ischemia modified albumin predicts short-term outcome and 1-year mortality in patients attending the emergency department for acute ischemic chest pain. Heart Vessels , 2008; 23(3): 174-180.
15. 16 Worster A, Devereaux PJ, Heels-Ausdell D, et al . Capability of ischemia-modified albumin to predict serious cardiac outcomes in the short term among patients with potential acute coronary syndrome. CMAJ , 2005, 172(13): 1685-1690.
16. 李丽, 高大胜. 缺血修饰白蛋白在冠心病临床应用中的研究进展. 中国急救医学, 2008, 28(8): 745-748.

Chinese Journal of Evidence-Based Medicine

Evaluation on Ischemia Modified Albumin in the Early Diagnosis of Non-St-Segment Elevation Acute Coronary Syndromes

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