Ischemia-modified Albumin as a Marker of Coronary Ischemia in Acute Organophosphorus-poisoned Patients: a Case-Control Study in Mansoura University Poison Unit

BackgroundThe diagnosis of cardiac ischemia remains a challenge in contemporary Emergency Medicine.A blood-borne biomarker is an attractive alternative to cardiac imaging and stress testing and would be cheaper and faster.Several candidate biomarkers have been proposed for the detection of cardiac ischemia; however, only Ischemia modified albumin (IMA) has been released for clinical use.IMA can be combined with electrocardiographic findings and cardiac troponin measurements for the early exclusion of acute coronary syndrome [1].Acute organophosphorus pesticide poisoning is a significant health problem throughout the world, with the increasing use of organophosphorus compounds in agriculture [2].Potentially lethal cardiac complications can occur in patients with acute organophosphate poisoning (OPP) and may be overlooked, leading to high morbidity and mortality rates of the poisoning.Cardiac complications of OPP may occur in the first few hours after exposure and may be delayed for days after poisoning [3].Cardiac troponin (cTn) is sensitive and specific for detection of myocardial damage but may not rise during a reversible Abstract Acute organophosphorus pesticide poisoning (OPP) is a significant health problem throughout the world.The diagnosis of cardiac ischemia remains a challenge in the Emergency Medicine, especially that cardiac troponin protein (cTn) may not rise during a reversible myocardial ischemia.Ischemia.Mo modified albumin (IMA) is suggested as an early and a sensitive biochemical marker of ischemia.This work aimed to assess the role of IMA in detecting cardiac ischemia in cases of OPP.IMA & cTnI were measured in 74 healthy control subjects and 48OPP cases attending to the Poison Unit in the Mansoura University Emergency Hospital.Sixty-nine contributors were male with an age range (17-68 years) and 53 were females with an age range (21-55 years).IMA & cTnI levels were repeated after 4 and 12 hours in the OPP patients, together with electrocardiogram (EGG) monitoring.It was found that IMA was earlier to rise in OPP cases suspected to have cardiac ischemia than cTnI and before changes appear in the ECG.There was a significantly higher IMA levels in those cases on presentation than the healthy control subjects (P=0.0001).IMA levels did not rise significantly after 4 & 12 hours of follow up (P= 0.01662), unlike cTnI that raised in suspected cardiac ischemia cases after 4 & 12 hours (P=0.0001).So, ischemia modified albumin (IMA) is a useful marker that can be used as an early indicator of cardiac ischemia in OPP cases.Serum cTnI and ECG can be used for further follow up of patients.