Sokhanvar S, Mellati A O, Mousavinasab S N, Taran L, Vahdani B, Golmmohamadi Z
Department of Cardiology, Zanjan University of Medical Sciences, Iran.
Bratisl Lek Listy. 2012;113(10):612-5. doi: 10.4149/bll_2012_138.
Early diagnosis of acute coronary syndrome (ACS) is an important factor in reducing mortality of this disease. Cardiac troponins are not elevated within first hours. So there is a need to optimize the clinical applicability and accuracy of novel ACS markers, particularly with regard to utilizing this technique in combination with other diagnostic methods.
In this prospective study, we examined 226 patients between July 2009 and March 2010, admitted with chest pain to emergency room (ER). The study groups constisted of 120 subjects presenting with chest pain whose initial and subsequent diagnosis was unstable angina (UA), and 106 subjects whose initial diagnosis was unstable angina but subsequent diagnosis was non ischemic chest pain(NICP). For each patient electrocardiogram (ECG), cardiac troponins (cTnT), creatinine phosphokinase (CPK), IMA levels were measured. We used McNemar's test for correlated proportions and logistic regression and ROC curve for achieving better result.
In this study median IMA values were definitely higher in patients with ACS compared with non ischemic chest pain (NICP) (p < 0.0001) (83.5 to 49.6). An IMA cut-off threshold derived from the receiver operating characteristics curve (ROC) was 85U/ml and gives 54 % (95%CI 51 to 56) sensitivity and 87 % (95%CI 83 to 92) specificity in our population. Negative predictive value was 62 % (95%CI 59 to 66). When IMA and ECG and cTnT were considered together sensitivity was 97.5 % and specificity was 63 %, respectively.
Ischemia-modified albumin did not provide superior sensitivity or specificity compared with other diagnostic tests (Tab. 1, Fig. 2, Ref. 25).
急性冠状动脉综合征（ACS）的早期诊断是降低该疾病死亡率的重要因素。心肌肌钙蛋白在最初几小时内不会升高。因此，有必要优化新型ACS标志物的临床适用性和准确性，特别是在将该技术与其他诊断方法联合使用方面。
在这项前瞻性研究中，我们于2009年7月至2010年3月期间对226例因胸痛入住急诊室（ER）的患者进行了检查。研究组包括120例最初诊断为不稳定型心绞痛（UA）且后续诊断仍为不稳定型心绞痛的胸痛患者，以及106例最初诊断为不稳定型心绞痛但后续诊断为非缺血性胸痛（NICP）的患者。对每位患者测量心电图（ECG）、心肌肌钙蛋白（cTnT）、肌酸磷酸激酶（CPK）和IMA水平。我们使用McNemar检验分析相关比例，并使用逻辑回归和ROC曲线以获得更好的结果。
在本研究中，ACS患者的IMA中位数明显高于非缺血性胸痛（NICP）患者（p < 0.0001）（83.5对49.6）。根据受试者操作特征曲线（ROC）得出的IMA临界阈值为85U/ml，在我们的研究人群中灵敏度为54%（95%CI 51至56），特异性为87%（95%CI 83至92）。阴性预测值为62%（95%CI 59至66）。当将IMA与ECG和cTnT一起考虑时，灵敏度分别为97.5%和特异性为63%。
与其他诊断测试相比，缺血修饰白蛋白并未提供更高的灵敏度或特异性（表1，图2，参考文献25）。
