Key result
The ischemia modified albumin test demonstrated a diagnostic area under the curve of 0.77 for detecting acute coronary syndrome in patients with normal ECG and cardiac markers.
Why the study?
Does ischemia modified albumin (IMA) testing accurately diagnose acute coronary syndrome in patients presenting within 5 hours of chest pain onset with normal ECG and cardiac markers?
Cross-Sectional (n=142)
Single-blind
No
Does ischemia modified albumin (IMA) testing accurately diagnose acute coronary syndrome in patients presenting within 5 hours of chest pain onset with normal ECG and cardiac markers?
Effect estimate: AUC 0.77 (95% CI 0.70-0.85)
p-value: p=<0.01
IMA may serve as a useful early diagnostic marker with high negative predictive value for ruling out ACS in patients presenting with chest pain and normal standard cardiac markers.
IMA may aid early ACS rule-out when ECG and markers are normal; leaves open adoption pending prospective validation.
Background and Objectives：In the early phase of acute chest pain, the diagnosis of acute coronary syndrome (ACS) is often difficult to achieve in an emergency department (ED) due to the non-diagnostic ECG and cardiac markers. Ischemia modified albumin (IMA) has recently been shown to be a sensitive early biochemical marker of ischemia. The aim of this study was to evaluate the diagnostic value of IMA for the patients with suspected ACS and who have normal ECG/cardiac markers. Subjects and Methods：We enrolled 142 consecutive patients who presented to the ED due to suspected ACS, and they had a normal EKG and troponin-I/CK-MB within 5 hours after the onset of their chest pain. The diagnosis of ACS was based upon the clinical findings, the results of serial ECG/troponin and the coronary angiography. The ideal cutoff value of IMA for ACS was calculated by the receiver operator characteristic (ROC) curve analysis. Results：The ACS was diagnosed in 80/142 (56%). The ROC curve area for the IMA test was 0.77 (CI; 0.70-0.85, p<0.01). At a cutoff value of 98.5 U/mL, the sensitivity, specificity and negative predictive values for ACS were 73%, 75% and 75%, respectively. At a cutoff value of 85 U/mL, the sensitivity and specificity and negative predictive values for ACS were 92%, 35% and 95%, respectively. Conclusion：IMA might be a useful diagnostic marker of ACS for those patients with normal ECG/cardiac markers and who present within 5 hours after the onset of chest pain. (Korean Circulation J 2005;35:928-933)
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Kim et al. (2005) conducted a cross-sectional in Suspected Acute Coronary Syndrome (n=142). Ischemia Modified Albumin (IMA) test vs. Final clinical diagnosis (ACS vs Non-ischemic chest pain) was evaluated on Diagnostic accuracy (Area Under the ROC Curve) for Acute Coronary Syndrome (AUC 0.77, 95% CI 0.70-0.85, p=<0.01). The ischemia modified albumin test demonstrated a diagnostic area under the curve of 0.77 for detecting acute coronary syndrome in patients with normal ECG and cardiac markers.
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