Abstract
Cardiac biomarkers have been emphasized as central to the diagnosis and risk stratification strategy for AMI by numerous clinical practice guidelines. Aim: To assess the diagnostic value of Ischemia -modified albumin (IMA) with standard biomarkers (CK-MB, LDH, and AST) troponin I [cTnI] in the early diagnosis of cardiac ischemia. Method: This is cross-sectional study was done 150 with patient’s acute chest pain as target population patients attending to the emergency department of Al Shab Hospital Khartoum. Every case was reviewed by a cardiologist. A clinical diagnosis of ischemia was assigned and correlated with biomarker test results. Results: 127 (84.7%) had myocardial ischemia. Receiver operating characteristic curves demonstrated IMA as highly sensitive but somewhat low specific for the presence of ischemia (area under curve, 0.878; P = .00). With a cut point of 88.16 U/mL, the IMA test had 84.6% sensitivity and 81% specificity for diagnosing ischemia and a negative predictive value of 77.9%. IMA was positive in 127 of 96 patients with electrocardiographic (ECG) evidence of ischemia and 31 of 127 patients with coronary ischemia but negative ECG. Among the same patients, the ECG and cTnI triad had a sensitivity of 64% and 24% respectively. The combination of IMA and ECG increased the sensitivity to (94.5%), and IMA, ECG, cTnI to 95.8%for detecting ischemia. IMA is highly sensitive and has a high negative predictive value, which might improve the usefulness of standard biomarkers of myocardial ischemia. Conclusion: Ischemia Modified Albumin has evaluated as highly sensitive, early diagnostic marker of among acute chest pain patients.
Highlights
Cardiac biomarkers have been emphasized as central to the diagnosis and risk stratification strategy for AMI by numerous clinical practice guidelines
Clinical Characteristics This study was conducted on 150 patients who arrived at the emergency department of Alshab Hospital, Sudan, Khartoum state, within two hours of acute chest pain as test group and 100 apparently healthy subjects' volunteers who didn't have any evidence of coronary artery disease
The Ischemia -modified albumin (IMA) measurement as a marker of myocardial ischemia without myocardial necrosis and/or preceding myocardial necrosis has introduced the hope for improved diagnosis in patients with ischemic heart disease (IHD) without or with non-specific ECG changes [20, 21]. in the cases with cardiac ischemia, it may be more difficult to reach at a diagnosis when the patient has acute chest pain with a non-diagnostic ECG and alteration in normal markers for necrosis
Summary
Cardiac biomarkers have been emphasized as central to the diagnosis and risk stratification strategy for AMI by numerous clinical practice guidelines. The current conventional cardiac markers, CK-MB, Troponin (I) and (T) are sensitive and specific tests for the detection of myocardial necrosis, but they show a greater rise approximately 3-6 hours after the onset of the myocardial cell injury and the patients may wait before they are diagnosed and treated; the usual biomarkers may not rise during reversible myocardial ischemia and other diagnostic tools such as stress testing, and echo cardiology are not routinely available [13a]. Inclusion criteria: Test group: Standardized clinical data were collected for each patient, which included time of presentation at the emergency department, approximate duration of symptoms of the acute chest pain
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