Kountana Evangelia, Tziomalos Konstantinos, Semertzidis Panagiotis, Dogrammatzi Fani, Slavakis Aristidis, Douma Stella, Zamboulis Chrysanthos, Geleris Paraschos
Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
Exp Clin Cardiol. 2013 Spring;18(2):98-100.
Several imaging tests and biomarkers have been proposed for the identification of patients with unstable angina among those presenting to the emergency department with acute chest pain. Preliminary data suggest that ischemia-modified albumin (IMA) may represent a potentially useful biomarker in these patients.
To compare IMA and echocardiography in excluding unstable angina in patients with acute chest pain.
Thirty-three patients (mean [± SD] age 59.8±10.8 years; 28 men) presenting to the emergency department with acute chest pain lasting <3 h suggestive of acute coronary syndrome, with normal or non-diagnostic electrocardiograms, and creatine kinase MB and troponin levels within the normal range, were included in the present study.
After further diagnostic evaluation, five patients (15.2%) were diagnosed with unstable angina. The sensitivity, specificity, positive predictive value and negative predictive (NPV) value of echocardiography for diagnosing unstable angina was 60.0%, 89.3%, 50.0% and 92.6%, respectively. The area under the ROC curve for diagnosing unstable angina based on the serum IMA levels was 0.193 (95% CI 0.047 to 0.339; P<0.05). Based on ROC curve analysis, serum IMA levels ≥31.95 IU/mL yielded the optimal combination of sensitivity and specificity for diagnosing unstable angina. The sensitivity, specificity, positive predictive value and NPV of serum IMA levels ≥31.95 IU/mL for diagnosing unstable angina was 40.0%, 28.6%, 9.1% and 72.7%, respectively.
Measurement of serum IMA levels appears to represent a useful tool for excluding unstable angina in patients presenting to the emergency department with acute chest pain. Moreover, IMA shows an NPV that is comparable with echocardiography.
对于在急诊科因急性胸痛就诊的患者，已经提出了几种影像学检查和生物标志物用于识别不稳定型心绞痛患者。初步数据表明，缺血修饰白蛋白（IMA）可能是这些患者中一种潜在有用的生物标志物。
比较IMA和超声心动图在排除急性胸痛患者不稳定型心绞痛方面的作用。
本研究纳入了33例因急性胸痛就诊于急诊科且胸痛持续时间<3小时、提示急性冠状动脉综合征、心电图正常或无诊断意义、肌酸激酶MB和肌钙蛋白水平在正常范围内的患者（平均年龄[±标准差]59.8±10.8岁；28例男性）。
经过进一步的诊断评估，5例患者（15.2%）被诊断为不稳定型心绞痛。超声心动图诊断不稳定型心绞痛的敏感性、特异性、阳性预测值和阴性预测值分别为60.0%、89.3%、50.0%和92.6%。基于血清IMA水平诊断不稳定型心绞痛的ROC曲线下面积为0.193（95%可信区间0.047至0.339；P<0.05）。基于ROC曲线分析，血清IMA水平≥31.95 IU/mL时，诊断不稳定型心绞痛的敏感性和特异性组合最佳。血清IMA水平≥31.95 IU/mL诊断不稳定型心绞痛的敏感性、特异性、阳性预测值和阴性预测值分别为40.0%、28.6%、9.1%和72.7%。
测定血清IMA水平似乎是排除急诊科急性胸痛患者不稳定型心绞痛的一种有用工具。此外，IMA的阴性预测值与超声心动图相当。
