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

Abstract

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.

Prognostic value of combination of heart‐type fatty acid‐binding protein and ischemia‐modified albumin in patients with acute coronary syndromes and normal troponin T values

“…Our observation also supports the study by others (22)(23)(24), because an ischemia event may cause as much or more damage to serum albumin and the surrounding tissue as ischemia itself.…”

Assay of ischemia‐modified albumin and C‐reactive protein for early diagnosis of acute coronary syndromes

“…Myocardial ischemia produced a lower metalbinding capacity for cobalt to albumin, which led to the development of the recently U.S. Food and Drug Administration (FDA)-cleared ACB test. In principle, cobalt added to serum does not bind to the NH 2 terminus of IMA, leaving more free cobalt to react with dithiothreitol and form a darker color in samples from patients with ischemia (16). According to the capacity of ACB, it reflected the IMA concentrations.…”

“…This ischemia-rendered change yields a compound known as IMA, which is rapidly detectable following the onset of coronary ischemia and, importantly, is elevated in states of coronary ischemia not only with, but also without, cardiac injury (15,16). The aim of this study was to compare the clinical performance of IMA and CRP, in patients presenting to the ED with symptoms suggestive of ACSs.…”

Effect of hemodialysis on traditional and innovative cardiac markers

“…The ischemia modified albumin (IMA) is increasingly regarded as a sensitive and early biochemical marker of ischemia (24)(25)(26). It has recently been suggested that IMA might be increased in patients with ESRD and its concentration would predict the prognosis of these patients (27).…”