Mohamed M Saker, Khaled A Elhefnawy, Mohamed El Sayed, Mohamed S Fawzy


An early identification of the patients with the Acute Coronary Syndrome (ACS) is of prime importance, due to the associated very high mortality. Only about 22% of the patients, who present at the emergency cardiology care centers with chest pain, have coronary disease. Ischemia modified albumin (IMA) is emerging as an exciting early marker of myocardial ischemia for diagnostic use in patients with suspected acute coronary syndrome (ACS). During an ischemic event, IMA concentrations in blood rise quickly above normal levels and remain elevated, returning to normal levels several hours after cessation of ischemia. IMA has recently been shown to be an early and sensitive marker of myocardial Ischemia. OBJECTIVE: The current study was to validate IMA or Albumin Cobalt Binding (ACB) assay when used together with standard markers of myocardial necrosis for the diagnosis and early detection of patients with ACS. METHODS: We enrolled 45 patients admitted to intensive cardiac care unit (ICCU) within 6 hours having acute chest pain and 15 healthy age and sex matched volunteers who didn't have any evidence of coronary artery disease to form the control group. The serum IMA level was estimated by the albumin cobalt binding test by using a digital spectrophotometer. At presentation serum IMA in conjunction with electrocardiogram (ECG) and cardiac enzymes Troponin I (cTnI) and CK-MB were evaluated. RESULTS: IMA levels were significantly higher in ischaemic patients compared to healthy controls. The sensitivity of IMA to detect ischaemia was 83.4% when IMA was combined with cTnI and CKMB, the sensitivity increased to 93%. CONCLUSIONS: IMA has been found to be a highly sensitive, early diagnostic marker of acute chest pain and earlier rule out test in ACS patients. The combined use of IMA and cardiac troponin I enhances the sensitivity and specificity. Hence, a combination of IMA and cardiac troponin I can be used as a more precise diagnostic marker for ACS.
Key words: Acute coronary syndrome (ACS), Cardiac ischemia, Cardiac biomarkers, Ischemia modified albumin (IMA)

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