Early Diagnosis of Acute Coronary Syndrome with Sensitive Troponin I and Ischemia Modified Albumin

Background: In this study we compared the diagnostic performance ofserum ischemia modified albumin (IMA) and sensitive cardiac troponin I (cTnI)assay for the detection of acute coronary syndrome (ACS) in patients presentingto the emergency department (ED) with acute chest pain.Methods: A prospective study was conducted on 123 patients presenting tothe ED within three hours of acute chest pain. A 12-lead ECG was recorded andIMA and cTnI were measured on arrival at the ED. After diagnostic testing, thepatients were classified as either ACS (n=70) or non- ACS (n= 53). The resultsof IMA, ECG, and cTnI, alone and in combination, were correlated with finaldiagnoses.Results: IMA showed higher sensitivity (84%) and negative predictivevalue (NPV, 88%) compared to cTnI (sensitivity 42%, NPV 66%) and ECG(sensitivity 58%, NPV 74%). Combined use of IMA, cTnI and ECG significantlyimproved the sensitivity (96%, P<0.05) and NPV (96%) of IMA. The diagnosticperformance of IMA was similar in the case of non-ST-segment-elevation ACS(sensitivity 80%, NPV 80%). The sensitivity and specificity of IMA for diagnosisof acute myocardial infarction (AMI) were 88% and 48%, respectively.Conclusion: Measuring IMA at the time of ED admission improves the earlydiagnosis of ACS and non-ST-segment-elevation ACS in patients with acute chestpain. However, the test is not an effective tool for diagnosis of AMI inpatients with chest pain presenting to ED.