| The usefulness of ischemia modified albumin as an early ischemic marker to detect coronary artery disease in patients with chest pain presenting to the emergency department |
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Eun Chul Jang, Hui Kyung Jeon, Seong Hun Kim, Dong Il Shin, Hae Bin Jeong, Jeong Ah Shin, Woo Sung Shin, Ki Yuk Jang, Young Sik Kim, Hae Kyung Lee, Kyoung Ho Choi, Ho Joong Youn, Wook Sung Chung, Jae Hyung Kim, Soon Jo Hong, Ki Bae Seung |
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고려대학교 의과대학 내과학교실 |
| 원저:흉통으로 응급실로 내원한 환자에서 조기에 관상동맥 질환을 진단 할 수 있는 새로운 허혈 표지자로서의 Ischemia Modified Albumin의 유용성 |
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장은철, Hui Kyung Jeon, Seong Hun Kim, Dong Il Shin, Hae Bin Jeong, Jeong Ah Shin, Woo Sung Shin, Ki Yuk Jang, Young Sik Kim, Hae Kyung Lee, Kyoung Ho Choi, Ho Joong Youn, Wook Sung Chung, Jae Hyung Kim, Soon Jo Hong, Ki Bae Seung |
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| Abstract |
Background : A diagnosis of coronary artery disease (CAD) in the early phase of acute
chest pain is often difficult in an emergency department (ED) due to the lower sensitive ECG
and delayed expression of the cardiac necrosis markers. Ischemia modified albumin (IMA) has
recently been reported to be an early sensitive biochemical marker of ischemia. The aim of this
study was to evaluate the diagnostic value of IMA in patients with suspected CAD and less
sensitive ECG/delayed cardiac necrosis markers.
Methods
: 100 consecutive patients (mean age: 5413 years, male: 66%) presenting to the ED
with suspected CAD and chest pain within 6 hours of chest pain were enrolled in this study.
An ECG check and blood sampling for IMA and CK-MB, cardiac troponin-T (TnT) were done
within 1 hour at the ED. The diagnosis of CAD was based upon the clinical findings, results
of serial ECG/TnT and coronary angiography. The ideal cutoff value of IMA for CAD was
calculated by the Receiver Operator Characteristic (ROC) curve analysis.
Results
: CAD including acute coronary syndrome was diagnosed in 69/100 (69%). The
optimum diagnostic cutoff point for the IMA levels in these study populations was found by
ROC analysis to be 99.5 U/mL. The ROC curve area for the IMA test was 0.901 (95%
confidential interval, 0.840-0.961, p=0.001). The IMA levels >99.5 U/mL demonstrated a sensitivity of 86%, specificity of 81%, positive predictive value of 90% and negative predictive
value of 74% for the diagnosis of CAD. The combination of IMA-ECG-CKMB/TnT increased
the sensitivity for detecting ischemia to 94%, with a negative predictive value of 85%. IMA is
a highly sensitive with a high negative predictive value, and might improve the utility of
standard biomarkers for CAD.
Conclusions
: IMA might be a useful ischemic marker of coronary artery disease in
patients presenting within 6 hours after the onset of chest pain.(Korean J Med 71:620-626, 2006)
Key Words : Acute chest pain, Ischemia modified albumin, Coronary artery disease |
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