ORIGINAL ARTICLE

Role of "Ischemia Modified Albumin", a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes

M K Sinha¹, D Roy¹, D C Gaze², P O Collinson², J-C Kaski¹

¹ Coronary Artery Disease Research Unit, St George’s Hospital Medical School, London, UK
² Chemical Pathology, St George’s Hospital, London, UK

Correspondence to:
Correspondence to:
Professor J-C Kaski
Coronary Artery Disease Research Unit, St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, UK; jkaski{at}sghms.ac.uk

Background: Diagnosis of cardiac ischaemia in patients attending emergency departments (ED) with symptoms of acute coronary syndromes is often difficult. Cardiac troponin (cTn) is sensitive and specific for the detection of myocardial damage but may not rise during reversible myocardial ischaemia. Ischemia Modified Albumin (IMA) has recently been shown to be a sensitive and early biochemical marker of ischaemia.

Methods and Results: This study evaluated IMA in conjunction with ECG and cTn in 208 patients presenting to the ED within three hours of acute chest pain. At presentation, a 12-lead ECG was recorded and blood taken for IMA and cardiac troponin T (cTnT). Patients underwent standardised triage, diagnostic procedures, and treatment. Results of IMA, ECG, and cTnT, alone and in combination, were correlated with final diagnoses of non-ischaemic chest pain, unstable angina, ST segment elevation, and non-ST segment elevation myocardial infarction. In the whole patient group, sensitivity of IMA at presentation for an ischaemic origin of chest pain was 82%, compared with 45% of ECG and 20% of cTnT. IMA used together with cTnT or ECG, had a sensitivity of 90% and 92%, respectively. All three tests combined identified 95% of patients whose chest pain was attributable to ischaemic heart disease. In patients with unstable angina, sensitivity of IMA used alone was equivalent to that of IMA and ECG combined.

Conclusions: IMA is highly sensitive for the diagnosis of myocardial ischaemia in patients presenting with symptoms of acute chest pain.

Keywords: acute coronary syndromes; ischemia modified albumin

Abbreviations: UA, unstable angina; AMI, acute myocardial infarction; IHD, ischaemic heart disease; ACS, acute coronary syndromes; NSTEMI, non-ST segment elevation infarction; STEMI, ST segment elevation myocardial infarction; IMA, Ischemia modified albumin; ED, emergency department; CTtn, cardiac troponins; NICP, non-ischaemic chest pain; NPV, negative predictive value; PPV, positive predictive value

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Primary Survey

Kevin Mackway-Jones
Emerg. Med. J. 2004 21: 1. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Manini, A F, Ilgen, J, Noble, V E, Bamberg, F, Koenig, W, Bohan, J S, Hoffmann, U (2009). Derivation and validation of a sensitive IMA cutpoint to predict cardiac events in patients with chest pain. Emerg. Med. J. 26: 791-796 [Abstract] [Full Text]  
• Sbarouni, E., Georgiadou, P., Koutelou, M., Sklavainas, I., Panagiotakos, D., Voudris, V. (2009). Ischaemia-modified albumin in dilated cardiomyopathy. Ann Clin Biochem 46: 241-243 [Abstract] [Full Text]  
• Franceschi, F, Deharo, J-C, Giorgi, R, By, Y, Monserrat, C, Condo, J, Ibrahim, Z, Saadjian, A, Guieu, R (2009). Peripheral plasma adenosine release in patients with chronic heart failure. Heart 95: 651-655 [Abstract] [Full Text]  
• Collinson, P O, Gaze, D C (2008). Ischaemia-modified albumin: clinical utility and pitfalls in measurement. J. Clin. Pathol. 61: 1025-1028 [Full Text]  
• Roy, D., Kaski, J. C. (2007). High-risk acute coronary syndrome patients and cardiac biomarkers in the emergency department: any role for new biomarkers of myocardial ischaemia?. Eur Heart J 28: 2297-2297 [Full Text]  
• Roy, D., Kaski, J. C. (2007). IMA the role of oxidative stress. Europace 9: 854-854 [Full Text]  
• Kalay, N., Cetinkaya, Y., Ozdogru, I. (2007). Ischemia-Modified Albumin and Myocardial Ischemia. J Am Coll Cardiol 49: 2375-2375 [Full Text]  
• Roy, D., Kaski, J. C. (2007). Ischemia-Modified Albumin: The Importance of Oxidative Stress. J Am Coll Cardiol 49: 2375-2376 [Full Text]  
• Sbarouni, E., Georgiadou, P., Panagiotakos, D., Livanis, E. G., Theodorakis, G. N., Kremastinos, D. Th. (2007). Ischaemia modified albumin in radiofrequency catheter ablation. Europace 9: 127-129 [Abstract] [Full Text]  
• Sbarouni, E., Georgiadou, P., Theodorakis, G. N., Kremastinos, D. Th. (2006). Ischemia-Modified Albumin in Relation to Exercise Stress Testing. J Am Coll Cardiol 48: 2482-2484 [Abstract] [Full Text]  
• Sinha, M K, Vazquez, J M, Calvino, R, Gaze, D C, Collinson, P O, Kaski, J C (2006). Effects of balloon occlusion during percutaneous coronary intervention on circulating Ischemia Modified Albumin and transmyocardial lactate extraction. Heart 92: 1852-1853 [Full Text]  
• Keating, L, Benger, J R, Beetham, R, Bateman, S, Veysey, S, Kendall, J, Pullinger, R (2006). The PRIMA Study: presentation ischaemia-modified albumin in the emergency department.. Emerg. Med. J. 23: 764-768 [Abstract] [Full Text]  
• Middleton, N., Shave, R., George, K., Whyte, G., Forster, J., Oxborough, D., Gaze, D., Collinson, P. (2006). Novel application of flow propagation velocity and ischaemia-modified albumin in analysis of postexercise cardiac function in man. Exp Physiol 91: 511-519 [Abstract] [Full Text]  
• Collinson, P O, Gaze, D C, Bainbridge, K, Morris, F, Morris, B, Price, A, Goodacre, S (2006). Utility of admission cardiac troponin and "Ischemia Modified Albumin" measurements for rapid evaluation and rule out of suspected acute myocardial infarction in the emergency department.. Emerg. Med. J. 23: 256-261 [Abstract] [Full Text]  
• Sinha, M. K., Roy, D., Kaski, J. C. (2006). Markers of myocardial ischaemia. Eur Heart J 27: 758-758 [Full Text]  
• Giannitsis, E., Katus, H. A. (2006). Markers of myocardial ischaemia: reply. Eur Heart J 27: 759-759 [Full Text]  
• Roy, D, Quiles, J, Gaze, D C, Collinson, P, Kaski, J C, Baxter, G F (2006). Role of reactive oxygen species on the formation of the novel diagnostic marker ischaemia modified albumin. Heart 92: 113-114 [Full Text]  
• Mitchell, A. M., Brown, M. D., Menown, I. B.A., Kline, J. A. (2005). Novel Protein Markers of Acute Coronary Syndrome Complications in Low-Risk Outpatients: A Systematic Review of Potential Use in the Emergency Department. Clin. Chem. 51: 2005-2012 [Abstract] [Full Text]  
• van der Zee, P. M., Verberne, H. J., van Straalen, J. P., Sanders, G. T.B., Van Eck-Smit, B. L.F., de Winter, R. J., Fischer, J. C. (2005). Ischemia-Modified Albumin Measurements in Symptom-Limited Exercise Myocardial Perfusion Scintigraphy Reflect Serum Albumin Concentrations but Not Myocardial Ischemia. Clin. Chem. 51: 1744-1746 [Full Text]  
• Worster, A., Devereaux, P.J., Heels-Ansdell, D., Guyatt, G. H., Opie, J., Mookadam, F., Hill, S. A. (2005). Capability of ischemia-modified albumin to predict serious cardiac outcomes in the short term among patients with potential acute coronary syndrome. CMAJ 172: 1685-1690 [Abstract] [Full Text]  
• Sabatine, M. S. (2005). When prognosis precedes diagnosis: putting the cart before the horse. CMAJ 172: 1697-1698 [Full Text]  
• Apple, F. S., Wu, A. H.B., Mair, J., Ravkilde, J., Panteghini, M., Tate, J., Pagani, F., Christenson, R. H., Mockel, M., Danne, O., Jaffe, A. S., on behalf of the Committee on Standardization of M, (2005). Future Biomarkers for Detection of Ischemia and Risk Stratification in Acute Coronary Syndrome. Clin. Chem. 51: 810-824 [Abstract] [Full Text]  
• Abadie, J. M., Blassingame, C. L., Bankson, D. D. (2005). Albumin Cobalt Binding Assay to Rule Out Acute Coronary Syndrome. Annals of Clinical & Laboratory Science 35: 66-72 [Abstract] [Full Text]  
• Roy, D., Quiles, J., Sharma, R., Sinha, M., Avanzas, P., Gaze, D., Kaski, J. C. (2004). Ischemia-Modified Albumin Concentrations in Patients with Peripheral Vascular Disease and Exercise-Induced Skeletal Muscle Ischemia. Clin. Chem. 50: 1656-1660 [Abstract] [Full Text]  
• Sinha, M K, Roy, D, Gaze, D C, Collinson, P O, Kaski, J-C (2004). Role of "Ischemia Modified Albumin", a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Heart 90: 644-644 [Full Text]  
• (2004). Ischemia Modified Albumin: A New Marker for Myocardial Ischemia?. JWatch Emergency Med. 2004: 3-3 [Full Text]  
• Sacchetti, A (2004). "Ischemia modified albumin": a new biochemical marker of myocardial ischaemia. Emerg. Med. J. 21: 3-4 [Full Text]