Capability of ischemia-modified albumin to predict serious cardiac outcomes in the short term among patients with potential acute coronary syndrome.
BACKGROUND
Ischemia-modified albumin (IMA) has been suggested as a marker of cardiac ischemia. Little, however, is known about its capacity to predict short-term serious cardiac outcomes (death, myocardial infarction, congestive heart failure, serious arrhythmia, or refractory ischemic cardiac pain) in patients arriving at the emergency department with symptoms that may indicate cardiac ischemia.


METHODS
We screened 546 patients over a 4-week period, of whom 189 fulfilled our entry criteria by presenting to an emergency department with potential cardiac-ischemia symptoms within 6 hours after chest pain, seeing an emergency physician who chose to order a troponin I test, and having no serious cardiac outcome before the troponin result became available. We followed the study patients for 72 hours to determine if any experienced a serious cardiac outcome. We calculated the likelihood ratios (LRs) of IMA findings predicting serious cardiac outcomes that could not be diagnosed at presentation with current techniques.


RESULTS
Of the 189 patients, 24 had a serious cardiac outcome within 72 hours after their arrival at the emergency department. The likelihood ratios for IMA measurement within 6 hours after chest pain predicting a serious cardiac outcome within the next 72 hours were 1.35 (95% confidence interval [CI] 0.315-5.79) for IMA < or = 80 U/mL and 0.98 (95% CI 0.86- 1.11) for IMA > 80 U/mL.


CONCLUSIONS
These data suggest that in patients presenting with chest pain who have not yet experienced a serious cardiac event, IMA is a poor predictor of serious cardiac outcomes in the short term.
Worster
Andrew
A
Department of Emergency Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ont.
Devereaux
P J
PJ
Heels-Ansdell
Diane
D
Guyatt
Gordon H
GH
Opie
John
J
Mookadam
Farouk
F
Hill
Stephen A
SA
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis*; D011379:Prognosis; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis*; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D012709:Serum Albumin; D019210:Troponin I