Predictive Role And Clinical Significance Of Serum Ischemia Modified Albumin And Deoxyribonuclease â…  In Early Diagnosis Of Acute Coronary Syndrome

BackgroundAcute coronary syndrome (ACS) is a common disease and a principal cause of death in adults, it's morbility and mortality rates are increasing year by year. Early diagnosis and treatment can improve prognosis of the patients. For the diagnosis of acute coronary syndr- ome (ACS) among patients having chest pain, clinical manifestations, electrocardiogram (ECG), and cardiac marker test are performed. Nevertheless, only approximately 30% of ACS patients manifest typical chest pain, and ECG is non-specific and normal finding can be seen in cardiac marker test in many of these cases.Myoglobin, creatine kinase-MB (CK- MB) and troponin have been used frequently as cardiac markers that are detectable in bloo d for conditions progressing to irreversible myocardial necrosis, but they are limited by th- eir insufficient sensitivity for reflecting the reversible ischemic condition in the initial on- set period. A large number of clinical researches have proved that ischemia modified albu- min(IMA) and Deoxyribonuclease I (DNase I), which have been found lately,are new bio- chemical marker of ischemia and can be detected sensitively and early. IMA and DNase I have great sensitivity in the early diagnosis and identification of acute myocardial ischemia and have more value for the dangerous delamination and prognosis.ObjectiveTo evaluate the clinical significance of serum ischemia modified albumin(IMA) and Deoxyribonuclease I (DNase I) in the early diagnosis of acute coronary syndrome (ACS), and dependability with serious degree, heart farction, predict value of prognostic.MethodsSerum IMA of 109 acute chest pain paitents of AMI(n=66) and UAP(n=43) in 12h , and hs-CRP in 24h were measured, and 57 persons were enrolled as controlled group who had no disease of ischemic. All enrolled patients had an ECG and blood collected immidiatly after arrival, and underwent standardized triage, diagnostic procedures and PCI treatment. Receiver operator characteristive curve(ROC curve)analysis was used to determine the optimal cut off of this assay for identifying individuals with ACS from non-ischemic individuals(NICP). Results of IMA, DNase I,ECG and cTnI were correlated with final diagnosis and their diagnostic sensitivity, specificity, negative predictive value, positive predictive value were evaluated for ACS. Measured left ventrichlar ejection fraction(LVEF), left ventrichlar end- unravelling stage interventricular septal thickness(IVST),left ventrichlar end-diastolicdiameter(LVDd), left ventricular posterior wall thickness(LVPWT),evaluate whether IMA and DNase I correlating with cardiac inadequacy. These patients were followed up to investigate the total mortality and the risk for major adverse cardiac events (MACE, including death, recurrent MI, recurrent angina, worsening heart failure, readmission for any reason) at 3 months, 6 months, 12 months was analyzed. The value of IMA and DNase I level in short-term prognosis in patients of heart failure were explored. Categorical variables are presented as percentage of patients; continuous variables are presented as mean values±SD. Differences between continuous variables were tested for statistical significance by means of t tests,and proportions were tested by X2 test. The association of continuous variables with the extent of ACS was tested by one-way analysis-of-variance. We assessed associations among variables with use of Pearson's correlation coefficient. All analyses were carried out using SPSS11.5 sofeware. P<0.05 was considered statistically significant.ResultsPart one:①Levels of IMA raised significantly higher in AMI patients(0.625±0.08 ABSU) than those in UAP patients (0.509±0.78 ABSU) and the controls (0.299±0.85 ABSU)(P<0.01). IMA level was positive correlation with level of hs-CRP in ACS( r =0.489 ,P<0.01).②S ensitivity of IMA for AMI was 92.4 % respectively. Combining results of IMA, cTnI and ECG advanced a sensitivity of 97 %.③Levels of IMA raised significantly higher in patients who heart function of Killip≥2(0.625±0.09 ABSU)than those patients of Killip=1(0.531±0.09 ABSU)(P<0.01), IMA level was negative correlation with level of ejection fraction(EF)(r=-0.104,P<0.01).④IMA increased with the increasing number of diseased coronary branches and Gensini's score.⑤Patients with MACE had significantly higher IMA level than those without MACE.Part tow:①Levels of DNase I raised significantly higher in AMI patients than those in the UAP and controls (P<0.01). Sensitivity of DNase I for AMI was 81.8 % respectively. Combining results of DNase I, IMA, cTnI and ECG advanced a sensitivity of 98.5 %.②DNase I level was positive correlation with level of hs-CRP in ACS( r =0.316 ,P<0.01) and level of IMA( r =0.658 ,P<0.01).③L evels of DNase I raised significantly higher in patients who heart function of Killip≥2(4.11±2.13 u/ml)than those patients of Killip=1(2.98±2.19 u/ml)(P<0.01), DNase I level was negative correlation with level of ejection fraction(EF)( r=-0.025,P<0.01).④Patients with MACE had significantly higher DNase I level than those without MACE.ConclusionIMA and DNase I could improve the early diagnosis of acute coronary syndrome. The elevated levels of IMA and DNase I may be the predictive marker for the clinical prognosis and heart function of ACS.