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Emerg Med J 2009;26:791-796 doi:10.1136/emj.2008.068130
  • Original Article

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

  1. A F Manini1,
  2. J Ilgen2,
  3. V E Noble3,
  4. F Bamberg4,
  5. W Koenig5,
  6. J S Bohan6,
  7. U Hoffmann4
  1. 1
    Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA
  2. 2
    Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, Massachusetts, USA
  3. 3
    Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4
    Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5
    Division of Cardiology, University of Ulm, Ulm,"" Germany
  6. 6
    Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. 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
  • Accepted 27 February 2009

Abstract

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.

Footnotes

  • Funding Cardiac Diagnostics Grant from Dade Behring (to JSB), Massachusetts General Hospital Departmental Award (to AFM) and in part by the National Institutes of Health (HL080053 to UH).

  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

Responses to this article

  • Assessment and risk stratification of patients with acute chest pain
    • Katherine McGinn,
    • Robert Taylor-Smith
    Emerg Med J published online October 30, 2009

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