title: Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department.
abstract: BACKGROUND
  Because of possible adverse outcomes, many of the >6 million annual emergency department (ED) patients with suspected acute coronary syndromes (ACS) undergo extensive evaluations. To minimize medical errors, chest pain evaluations are structured to identify accurately nearly 100% of patients with ACS. This is at a cost of negative evaluation rates that can exceed 90%. Ischemia-modified albumin (IMA), a serum biomarker with a high negative predictive value (NPV) at ED presentation, may exclude ACS. Our objective was to perform a meta-analysis of IMA use for ACS risk stratification.
  
  
  METHODS
  By computer literature search and communication with authors of unpublished information, all IMA data were considered. This analysis included studies if they reported IMA results from an ED presentation for suspected ACS. We defined a negative triple prediction test (TPT) as a nondiagnostic electrocardiogram, negative troponin, and negative IMA.
  
  
  RESULTS
  Eight studies of >1800 patients met the entry criteria. The TPT sensitivity and NPV for acute ACS were 94.4% and 97.1% and, for longer-term outcomes, were 89.2% and 94.5%, respectively.
  
  
  CONCLUSIONS
  A negative TPT of a nondiagnostic electrocardiogram, negative troponin, and negative IMA has a high NPV for excluding ACS in the ED.
authors.affiliation: Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Peacock
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Morris
authors.forename: Saif
authors.initials: S
authors.lastname: Anwaruddin
authors.forename: Robert H
authors.initials: RH
authors.lastname: Christenson
authors.forename: Paul O
authors.initials: PO
authors.lastname: Collinson
authors.forename: Steve W
authors.initials: SW
authors.lastname: Goodacre
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Robert L
authors.initials: RL
authors.lastname: Jesse
authors.forename: Juan C
authors.initials: JC
authors.lastname: Kaski
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kontos
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lefevre
authors.forename: Dave
authors.initials: D
authors.lastname: Mutrie
authors.forename: Manas K
authors.initials: MK
authors.lastname: Sinha
authors.forename: Denise
authors.initials: D
authors.lastname: Uettwiller-Geiger
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
mesh_terms: D000789:Angina, Unstable / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000032:analysis; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012709:Serum Albumin / Q000032:analysis*; D013577:Syndrome
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D052279:Creatine Kinase, MB Form