Clinical Significance Of Ischemia Modified Albumin In Patients With Acute Chest Pain

Objective: Chest pain is a common clinical symptom, about 5% of the total number of emergency were patients of chest pain. It is more important that acute chest pain is a main clinical manifestations of the acute coronary syndrome(ACS). ACS is the clinical syndrome caused by acute myocardial ischemia. It is a common clinical cardiovascular emergencies and also a common cause of sudden cardiac death. Hence, if we can early identify the cause of acute chest pain and treated it earlier, that will have a very great significance to reduce the mortality rates and improve the prognosis of ACS. In recent years, the markers of myocardial injury have a rapid development. Ischemia modified albumin(IMA)-a new marker of myocardial ischemia are gradually bring about the attention of the people. IMA levels were changed in the earlier stage of myocardial ischemia and returned to the base levels whithin 24 hours, so it can be detected in the recurrence of ischemia. This study is in contrast IMA with the traditional biochemical markers of myocardial ischemia to evaluate the value of early diagnostis of IMA.Methods: 80 patients (54 males and 26 females; mean age 55.4±8.6 years) were sent to the hospital within three hours of acute chest pain in this study. All enrolled patients must except for pregnancy or following diseases: such as acute renal failure, acute cerebrovascular disease, serum albumin abnormalities, peripheral vascular disease (intermittent claudication), cirrhosis, certain serious infectious, or cancer etc. Blood samples of all patients were collected at immediately, 3 h and 24 h after Admission, and were detected IMA, troponin I(cTnI) and creatine kinase-MB(CK-MB). The changes of ECG were carefully observed in all patients. The patients were divided into both ischemic chest pain(ICP) and non-ischemic chest pain(NICP) of groups based on the final diagnosis. ICP group was furtherly divided into unstable Angina(UA) group and acute myocardial infarction(AMI) group. The result of IMA was detected in comparison with the result of cTnI, CK-MB and ECG so that to evaluate the clinical significance of IMA.Results: Among the 80 patients, it was diagnosed as UA 36 cases, AMI 7 cases and NICP 37 cases. IMA levels were significantly higher in the patients of ICP within 3 hours and between 3 and 6 hours than that patients of NICP, but beyond 24 hours there was no difference between ICP and NICP. There was no distinction of IMA levels between UA group and AMI group. Sensitivity and negative predictive value of IMA for ICP, within three hours was 93% and 91%, higher than that of cTnI, ECG and CK-MB. Sensitivity and negative predictive value of IMA between 3 and 6 hours after onrset of ICP was 81% and 78%, and also higher than the other three. But IMA level was not able to diagnosis ICP beyond 24 hours.Conclusion: IMA is a sensitive biochemical marker in the early distinction of ICP and NICP. For diagnosis of ICP, IMA have higher sensitivity and negative predictive value within six hours, and combined with other markers can be further improved the diagnostic value of the ICP. But IMA can not distinguish ischemia from necrosis, so it can not be used to distinguish UA from AMI.