Early Diagnosis of Brain Natriuretic Peptide (Pro-BNP) and Ischemia Modified Albumin (IMA) Levels in Acute Coronary Syndrome Patients with ST Segment Elevation Myocardial Infarction (STEMI) and Non ST Segment Elevation Myocardial Infarction (NSTEMI)

Abstract

Background: Acute coronary syndrome (ACS) can be classified to ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina. The challenging in acute coronary syndrome remains, as it does not detect the myocardial ischemia by cardiac troponin and creatine kinase-MB. Pro brain-type natriuretic peptide (pro-BNP) was released when the heart need to hard works, which leads of retention fluid and expansion of veins and arteries. Therefore, this hormone release in the response of the changes of pressure in the heart especially for patients with ACS, which be benefit to use as an indicator to evaluate health problem that related with heart. Ischemia modified albumin (IMA) is a form of human serum albumin in which the N-terminal amino acids have been modified by ischemia as the result of acidosis, damaging occurs by free radicals, fatty acids releasing, exposures to free copper and iron, and disturbance of calcium pump. The aim of this study was to estimate the brain natriuretic peptide (Pro-BNP) and Ischemia Modified Albumin (IMA) Levels as early diagnostic markers and correlated with conventional cardiac markers at admission to the emergency department in Acute Coronary Syndrome Patients with ST segment elevation myocardial infarction (STEMI) and Non ST segment elevation myocardial infarction (NSTEMI). Methods: Eighty ACS patients who arrived at the emergency department ED within 6h of clinical symptoms divided to STEMI and NSTEMI, and another 40 of noncardiac chest pain patients (NCCP) as control were enrolled in this study. pro-BNP was measured using a Cobas e 411 Roche, Germany, and IMA was measured using enzyme linked immunosorbent assay (ELISA) kits. Tukey HSD Post hoc ANONA test and One-way ANOVA were used to compare differences of mean between groups. Pearson Correlation was calculated to assess the relation between the biomarkers of this study. Receiver Operating Characteristics (ROC) curve was calculated to estimate the sensitivity and specificity for the use of pro-BNP and IMA as biomarker in the diagnosis and discriminatory ability of ACS. Results: pro-BNP and Ischemia modified albumin were significantly higher in acute coronary syndrome patients (STEMI & NSTEMI) compared to NCCP as controls (1359.82± 995.00 and 2698.22±1604.69 vs 180.07±90.24) (p