title: A synergistic role of ischemia modified albumin and high-sensitivity troponin T in the early diagnosis of acute coronary syndrome.
abstract: OBJECTIVE
  The aim was to evaluate the role of high sensitivity troponin T and ischemia modified albumin (IMA) and in the early diagnosis of acute coronary syndrome (ACS).
  
  
  METHODS
  This was a cross-sectional study that comprised of 120 individuals of which 75 were cases and 45 healthy controls. On the basis of clinical history and 12-lead electrocardiogram, initial diagnosis of ACS was made in the cases. High sensitive cardiac troponin T (hs-cTnT) and IMA were measured in all the individuals.
  
  
  RESULTS
  Levels of IMA were significantly higher in patients of ACS as compared to those in control group (means: 101.83 [95% confidence interval (CI): 91.96-111.70] vs. 41.11 [95% CI: 38.55-43.67]). By taking the cut-off as >65.23 U/mL for IMA, which was obtained from receiver operating characteristic (ROC) curve, the sensitivity was 91.3%, specificity was 81.1%, positive predictive value (PPV) was 74.4%, and negative predictive value (NPV) was 93.9%. Positive likelihood ratio was 4.83 while negative likelihood ratio was 0.11, whereas the corresponding values in case of hs-cTnT were 95.6% (95% CI: 85.2-99.5), 61.3% (95% CI: 49.5-72.6), 59.7%, 95.8%, 2.47 and 0.07 by taking cut-off as >14 pg/mL. The area under the ROC curves (AUC) of IMA and hs-cTnT at 0-6 h were 0.932 (95% CI: 0.87-0.97, P < 0.001) and 0.797 (95% CI: 0.71-0.86, P < 0.001), respectively. The logistic model combining the two markers yielded sensitivity, specificity, PPV, and NPV of 95.7%, 81.1%, 88.6%, and 92.5% respectively.
  
  
  CONCLUSIONS
  hs-cTnT and IMA may be useful tools for risk stratification of ACS and can be used together with better accuracy in the early diagnosis of ACS.
authors.affiliation: Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: Mihir D
authors.initials: MD
authors.lastname: Mehta
authors.affiliation: Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: Simbita A
authors.initials: SA
authors.lastname: Marwah
authors.affiliation: Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: S
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: Hitesh N
authors.initials: HN
authors.lastname: Shah
authors.affiliation: Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: Amit P
authors.initials: AP
authors.lastname: Trivedi
authors.affiliation: Department of Biochemistry, Pramukhswami Medical College, Shree Krishna Hospital, Karamsad, Anand, Gujarat, India.
authors.forename: N
authors.initials: N
authors.lastname: Haridas
keywords: Acute coronary syndrome; high sensitivity troponin T; ischemia modified albumin