ORIGINAL ARTICLES

Derivation and validation of a sensitive IMA cutpoint to predict cardiac events in patients with chest pain

A F Manini¹, J Ilgen², V E Noble³, F Bamberg⁴, W Koenig⁵, J S Bohan⁶, U Hoffmann⁴

¹ Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA
² Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, Massachusetts, USA
³ Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
⁴ Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, Massachusetts, USA
⁵ Division of Cardiology, University of Ulm, Ulm,"" Germany
⁶ Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

Correspondence to:
^{Correspondence to} Dr Alex F Manini, Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustrave L Levy Place, Box 1620, New York, NY 10029, USA; alex.manini{at}mountsinai.org

Objectives: In patients with acute chest pain, we derived a cutpoint for ischaemia-modified albumin (IMA) and prospectively validated this cutpoint to predict 30-day major adverse cardiac events (MACEs).

Methods: We prospectively recruited a derivation cohort (18-month period) to establish a serum IMA cutpoint targeting 80% sensitivity. This was followed by a prospective validation cohort study of emergency department patients with acute chest pain at two university hospitals over a 3-month period. A MACE was defined as myocardial infarction, revascularisation or death at 30-day follow-up.

Results: In the derivation cohort of 151 patients, the IMA cutpoint that achieved 80% sensitivity for MACEs was 75 KU/litre. The sensitivity was prospectively validated in 171 patients consecutively enrolled, of whom 106 underwent multiple-biomarker analysis (19.8% MACE rate, 81% sensitivity of IMA). Furthermore, IMA by itself (81%, p<0.01) and in combination with initial highly sensitive cardiac troponin T (hsTnT) (90%, p<0.001) had significantly higher sensitivity than initial hsTnT (29%) for prediction of MACEs.

Conclusions: We prospectively validated the sensitive IMA cutpoint of 75 KU/litre with 80% sensitivity for MACEs in patients with acute chest pain. Our data suggest that IMA alone and in combination with initial hsTnT are more sensitive than the initial hsTnT for MACEs.

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Assessment and risk stratification of patients with acute chest pain

Katherine McGinn, et al.

EMJ Online, 30 Oct 2009 [Full text]