Bhakthavatsala Reddy C, Cyriac Cijo, Desle Hrishikesh B
Associate Professor, Department of Cardiology, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India.
Assistant Professor, Department of Cardiology, Narayana Medical College & Hospital, Nellore, Andhra Pradesh, India.
Indian Heart J. 2014 Nov-Dec;66(6):656-62. doi: 10.1016/j.ihj.2014.12.005. Epub 2014 Dec 22.
Diagnosis of acute coronary syndrome (ACS) is important, due to the associated very high mortality. Failure to diagnose ACS is a problem both for the patients and the clinicians. Ischemia modified albumin (IMA) has already been licensed by the US Food and Drug Administration for the diagnosis of suspected myocardial ischemia.
Patients attending the emergency department (ED) within 6 h after having features of ACS were selected. IMA was done on admission. Blinded to the IMA results patients were fully evaluated and a diagnosis of non-ischemic chest pain (NICP), unstable angina (UA) or myocardial infarction (MI) was made. Later IMA results were correlated in each group.
Mean IMA value was 56.38 ± 23.89 u/ml in NICP group whereas in UA group it was 89.00 ± 7.76 u/ml and MI group was 87.50 ± 9.62 u/ml. This showed a sensitivity of 92% and specificity of 87%. The positive predictive value of the test was 88% and negative predictive value was 94%. In 16 patients an early diagnosis could be made when compared with Trop-T. Of the 89 patients 11 patients died in hospital. The IMA value was compared between this group and the patients who survived. Patients who died had a mean IMA value of 88.5 with a standard deviation of 5.33 whereas in patients who survived the mean value was 78.26 which was not statistically significant.
In conclusion the benefit of the test would be to rule out ACS in patients who present early to ED with inconclusive diagnosis.
急性冠状动脉综合征（ACS）的诊断至关重要，因为其死亡率极高。未能诊断出ACS对患者和临床医生来说都是个问题。缺血修饰白蛋白（IMA）已获美国食品药品监督管理局批准用于疑似心肌缺血的诊断。
选取在出现ACS症状后6小时内就诊于急诊科（ED）的患者。入院时检测IMA。在不知IMA结果的情况下对患者进行全面评估，并做出非缺血性胸痛（NICP）、不稳定型心绞痛（UA）或心肌梗死（MI）的诊断。之后将每组的IMA结果进行对比。
NICP组的平均IMA值为56.38±23.89 U/ml，UA组为89.00±7.76 U/ml，MI组为87.50±9.62 U/ml。这表明其敏感性为92%，特异性为87%。该检测的阳性预测值为88%，阴性预测值为94%。与肌钙蛋白T（Trop-T）相比，16例患者得以早期诊断。89例患者中有11例在医院死亡。将该组患者与存活患者的IMA值进行比较。死亡患者的平均IMA值为88.5，标准差为5.33，而存活患者的平均值为78.26，差异无统计学意义。
总之，该检测的益处在于排除早期就诊于急诊科且诊断不明确的患者的ACS。
