title: Ischemia-modified albumin improves the usefulness of standard cardiac biomarkers for the diagnosis of myocardial ischemia in the emergency department setting.
abstract: We studied the role of ischemia-modified albumin (IMA) with standard biomarkers (myoglobin, creatine kinase-MB [CK-MB], troponin I [TnI]) in assessment of 200 patients with suspected myocardial ischemia admitted to the emergency department. Every case was reviewed by a cardiologist. A clinical diagnosis of ischemia was assigned and correlated with biomarker test results. Of the patients, 25 (13.0%) had myocardial ischemia. Receiver operating characteristic curves demonstrated IMA as highly sensitive but somewhat poorly specific for the presence of ischemia (area under curve, 0.63; P = .01). With a cut point of 90 U/mL, the Albumin Cobalt Binding Test had 80% sensitivity and 31% specificity for diagnosing ischemia and a negative predictive value of 92%. IMA was positive in 4 of 5 patients with electrocardiographic (ECG) evidence of ischemia and 16 of 20 patients with coronary ischemia but negative ECG. Among the same patients, the myoglobin-CK-MB-TnI triad had a sensitivity of 57%. The combination of IMA-myoglobin-CK-MB-TnI increased the sensitivity for detecting ischemia to 97%, with a negative predictive value of 92%. IMA is highly sensitive and has a high negative predictive value, which might improve the usefulness of standard biomarkers of myocardial ischemia.
authors.affiliation: Department of Internal Medicine, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
authors.forename: Elizabeth Lee
authors.initials: EL
authors.lastname: Lewandrowski
authors.forename: Kent B
authors.initials: KB
authors.lastname: Lewandrowski
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004562:Electrocardiography; D004632:Emergency Medical Services; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis*; D009206:Myocardium / Q000473:pathology; D009211:Myoglobin / Q000097:blood; D009336:Necrosis; D012709:Serum Albumin / Q000378:metabolism*; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D009211:Myoglobin; D012709:Serum Albumin; D019210:Troponin I; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form