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Role of “Ischemia Modified Albumin”, a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes
  1. M K Sinha1,
  2. D Roy1,
  3. D C Gaze2,
  4. P O Collinson2,
  5. J-C Kaski1
  1. 1Coronary Artery Disease Research Unit, St George’s Hospital Medical School, London, UK
  2. 2Chemical Pathology, St George’s Hospital, London, UK
  1. Correspondence to:
 Professor J-C Kaski
 Coronary Artery Disease Research Unit, St George’s Hospital Medical School, Cranmer Terrace, London SW17 0RE, 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.

  • acute coronary syndromes
  • ischemia modified albumin
  • 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

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  • Funding: MKS is the recipient of an unrestricted educational grant from Ischemia Technologies and POC is on the scientific advisory board of Ischemia Technologies.

  • Conflicts of interest: none declared.

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