Derivation and validation of a sensitive IMA cutpoint to predict cardiac events in patients with chest pain.
OBJECTIVE
In patients with acute chest pain, we derived a cutpoint for ischaemia-modified albumin (IMA) and prospectively validated this cutpoint to predict 30-day major adverse cardiac events (MACEs).


METHODS
We prospectively recruited a derivation cohort (18-month period) to establish a serum IMA cutpoint targeting 80% sensitivity. This was followed by a prospective validation cohort study of emergency department patients with acute chest pain at two university hospitals over a 3-month period. A MACE was defined as myocardial infarction, revascularisation or death at 30-day follow-up.


RESULTS
In the derivation cohort of 151 patients, the IMA cutpoint that achieved 80% sensitivity for MACEs was 75 KU/litre. The sensitivity was prospectively validated in 171 patients consecutively enrolled, of whom 106 underwent multiple-biomarker analysis (19.8% MACE rate, 81% sensitivity of IMA). Furthermore, IMA by itself (81%, p<0.01) and in combination with initial highly sensitive cardiac troponin T (hsTnT) (90%, p<0.001) had significantly higher sensitivity than initial hsTnT (29%) for prediction of MACEs.


CONCLUSIONS
We prospectively validated the sensitive IMA cutpoint of 75 KU/litre with 80% sensitivity for MACEs in patients with acute chest pain. Our data suggest that IMA alone and in combination with initial hsTnT are more sensitive than the initial hsTnT for MACEs.
Department of Emergency Medicine, Mount Sinai School of Medicine, One Gustrave L Levy Place, Box 1620, New York, NY 10029, USA. alex.manini@mountsinai.org
A F
AF
Manini
J
J
Ilgen
V E
VE
Noble
F
F
Bamberg
W
W
Koenig
J S
JS
Bohan
U
U
Hoffmann
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D017202:Myocardial Ischemia / Q000175:diagnosis*; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D020107:Troponin T / Q000097:blood; D055815:Young Adult
D015415:Biomarkers; D012709:Serum Albumin; D020107:Troponin T