The Application Value Of Albumin-adjusted Ischemia Modified Albumin Index As An Early Screening Marker For Acute Coronary Syndrome

Background:In the presence of ischaemia,albumin undergoes changes resulting in the formation of ischaemia-modified albumin (IMA). Increased concentration of serum IMA has been found in patients with acute coronary syndrome (ACS). Some reports show that there is a closely relationship between the concentration of IMA and the concentration of serum albumin. Serum albumin concentration is important influencing factor of IMA.So it is recommended that the effects of serum albumin should be taken into the determination of IMA.At present, there is no study on relationship between serum albumin and IMA in China.ObjectiverTo explore the value of IMA to diagnose ACS in prophase;To explore the relationship between the concentration of EMA and the concentration of serum albumin.;To explore the value of albumin-adjusted EMA index to diagnose ACS in prophase,and that when combined the Hs-CRP.Methods:We enrolled60healthy subjects to observe the relationship between the concentration of IMA and the concentration of serum albumin. We also enrolled163consecutive patients(onset of sydroms≤3hours) with symptoms suggestive of acute coronary syndrome (ACS). All patients were devided into either the ACSgroup (n=79) which including32patients with AMI and47patients with UA or other4non-ACS groups (n=84).Determine the IMA, concentration of serum albumin and Hs-CRP of all163patients.Results:The concentration of EMA in ACS group and non-ACS group were70.03±18.20ABSU/mL and52.98±15.29ABSU/mL, P<0.05. In ROC analys, the area under the curve (AUC) was0.764.For an optimum EMA cutoff of58.84ABSU/mL, the sensitivity and specificity were81%and64%, respectively. In60healthy subjects, the mean value of EMA and concentration of serum albumin were50.92±10.25ABSU/mL and44.1±3.10g/L, respectively; The correlation coefficients for EMA and serum albumin was-0.956. In the ROC analysis of the applied albumin-adjusted EMA index, AUC was0.84, and for the ACS diagnosis with an applied cutoff of53.15ABSU/mL, the sensitivity and specificity were89%and68%, respectively. The sensitivity and specificity of albumin-adjusted EMA index combined Hs-CRP for ACS diagnosis were94.5%and71.4%, respectively.Conclusion:the EMA test have superior sensitivity for the early screening of ACS. However, its diagnostic specificity was low; EMA was significantly negatively correlated with serum albumin concentration. Album in-adjusted IMA index is recommended to increase the sensitivity of theACS diagnosis. Albumin-adjusted IMA index combined Hs-CRP can further increase thesensitivity and specificity of the ACS diagnosis.