Clinical Value Of Ischemia Modified Albumin In The Diagnosis Of Acute Coronary Syndrome

Background and purpose:with China’s rapid economic development, people’s eating habits andlifestyle were changed, obesity, high blood fat, diabetes, hypertension and otherrisk factors of coronary heart disease CHD in China increased, the incidenceand mortality rates are rising rapidly. Coronary heart disease is due to coronaryatherosclerosis caused by stenosis or occlusion, or on the basis of combinedspasm, thrombosis increased luminal obstruction caused by myocardialnutrition, arterial insufficiency, myocardial ischemia, hypoxia or infarct onekind of heart disease. This paper aims to explore the IMA on early diagnosis ofacute coronary syndrome on ACS value, early diagnosis and treatment play apositive role.Methods:in2010June-2011June No.1Hospital of Jilin University due to chest painin the emergency treatment, and the final diagnosis of96patients with ACSwere in group ACS, male60, female36, age45~79year old, average age (65+/-11) years of age. Non ST segment elevation myocardial infarction in35cases,ST segment elevation myocardial infarction in44cases,17cases of unstableangina pectoris. ACS diagnosis standard of American College of Cardiology(ACC)/American Heart Association (AHA) in unstable angina pectoris andnon ST segment elevation myocardial infarction treatment guidelines (revisededition in2007) and2004ACC/AHA ST segment elevation myocardialinfarction treatment guide.100healthy physical examination as control group,male, female50, age40~70year old, average age of (52+7), and according toage is further divided into3subgroups,40~49years old group35,50~59years old group and40,60~69years old group25. All study subjects were except inthe brain injury and accident, late stage of uremia and renal function inend-stage, severe liver disease, infectious diseases, infectious diseases,gastrointestinal diseases and malignant tumor.The control group and ACS group patients in the hospital immediatelyafter the detection of ischemia modified albumin (IMA,>85U/m as positive)and cardiac troponin I (cTN I,>014ng/ml as positive) content, recording18lead ECG (adjacent to the2lead ST segment horizontal or inclined typedepression>0.5mV or Camponotus elevation greater than or equal to1mVpositive), ACS case group and in2h,4h, cTNI and IMA12h after the review.And in the2H to determine the best IMA bound value (Cutoff value), will beadmitted to hospital immediately and4h cTNI IMA to evaluate cTNI positivepredictive value.The results：A case of group IMA levels compared with the control group thedifference is significant (P <0.05). Further comparison of the Q test resultsshow, non ST segment elevation myocardial infarction group, ST segmentelevation myocardial infarction group serum IMA levels compared with thecontrol group with significant difference (P <0.05), unstable angina groupcompared with the control group, no significant difference (P>0.05).IMA, cTnI to assess the extent of myocardial damage in patients with ACS,IMA level: ST segment elevation myocardial infarction group> non STsegment elevation myocardial infarction group, unstable angina group. Thus inacute myocardial ischemia occurred early diagnosis is madeIMA separatediagnostic sensitivity of ACS up to82%-96%, the specificity was46%, thenegative predictive value (NPV) of91%. Combined ECG and troponin I indiagnosis of myocardial ischemia, the sensitivity can be improved to95%. This means that the ACS of early onset IMA can indeed improve the traditionalexamination method for the diagnosis of effectiveness.The area under the ROC curve of0.943,95%confidence interval(0.931,0.955). When choosing0.50ABSU as the cutoff value, IMA sensitivity,specificity, negative predictive value, positive predictive values were higher,the correct diagnosis of the highest index, this study will identify0.50ABSU asa cutoff value. The sensitivity of IMA was84.4%, specificity was96.1%, thenegative predictive value was95.6%, the positive predictive value was79.2%,the correct diagnosis index is0.795, the diagnostic efficiency of89%,The study on96cases of emergency ACS patients dynamic detection ofserum levels of IMA, IMA and cTnI were found on admission after4~24hpeak, show that: by UA AMI development process, the extent of myocardialischemia aggravates gradually, IMA levels rise correspondingly. Caused byischemia necrosis of the myocardium area increased, cTnI levels increasedrapidly, the level of IMA increased UA AMI tips to progress; UA can also betransformed into stable angina, with ischemic degree of ease, IMA levelsrapidly returned to normal. The IMA levels predict the turnover of UA, AMI beused as auxiliary diagnostic index.This study of96patients with ACS were IMA, cTnI and ECG alone andcombined diagnosis effect comparison, and confirmed that the IMA in thediagnosis of ACS was more sensitive than traditional indicators, IMA alone,the diagnosis of ACS was more sensitive than cTnI and ECG (78.3%vs43.9%vs52.5%), the difference was statistically significant. CTnI, ECG and IMAcombined sensitivity increased to89.9%and92.4%, if the three joint sensitivityrises to99%, greatly reducing the rate of missed diagnosis of ACS.Conclusion:1IMA as the early diagnosis of acute myocardial ischemia index, haveimportant clinical significance. 2IMA of ACS in the diagnosis and differential diagnosis value of ACShas a certain auxiliary, serum IMA levels were significantly higher than healthycontrols, the difference has statistical significance.3Can effectively distinguish ischemic chest pain patients with andwithout ischemic chest pain patients4IMA and cTnI can improve the early detection of acute myocardialischemia sensitivity.