Ischemia-Modified Albumin (IMA) for early detection of myocardial ischemia in acute coronary syndrome with type 2 diabetes mellitus: a case control study

Abstract

Abstract Introduction: Evaluation of the patients who present to the hospital with a complaint of chest pain or other signs suggestive of acute coronary syndrome (ACS) is time-consuming, expensive, and difficult. Most of the biochemical markers are negative in early phase acute myocardial ischemia. Recent literature reports have shown more interest in a new biochemical marker which is Ischemia-modified albumin for the detection of myocardial injury. Objective: to estimate the level of ischemia-modified albumin (IMA) as a risk factor for cardiovascular disease in diabetes mellitus patients. Materials and methods: A case-control study was undertaken with sixty Type-2 diabetic patients as cases and sixty non-diabetic healthy subjects as controls. Demographic data (sex, age), an ECG and Biochemical data were collected. Blood for IMA and HbA1C levels was collected within two hours of arrival, and IMA risk marker testing was performed before any heparin/thrombolytic treatment was started. Controlled and uncontrolled diabetic patients were determined by the level of their HBA1c and comparison with the means of IMA level in their serum. Results: The IMA was significantly increased in diabetic patients compared to healthy controls, with cut off value (0.92 IU/L), and there is also a significant increase in IMA level in uncontrolled diabetic patients (Mean ± SD; 240.55 + 52.5) that presented with acute chest pain and have signs and symptoms of cardiac ischemia when compared with the well-controlled diabetic patients(Mean ± SD; 159.8 ± 60.4). Conclusion: Ischemic Modified Albumin (IMA) level was elevated significantly in uncontrolled diabetic patients with early signs of early myocardial ischemia. Additionally, IMA estimation may improve our ability to identify ischaemic patients who are missed by current diagnostic strategies, or more confidently rule out patients who do not have ACS.