ABSTRACT
Establishing a diagnosis of acute coronary syndrome in the clinical setting remains a challenging task. The advent of testing for cardiac biomarkers such as myoglobin, creatine kinase [CK-MB], and the troponins has facilitated this process. Unfortunately, although these blood markers are extremely sensitive for the identification of patients with myocardial necrosis, their ability to identify patients with acute coronary ischaemia remains limited. During myocardial ischaemia, several changes occur in the amino terminus of ischaemia, several changes occur in the aminot terminus of albumin. Therefore, if reliable, an assay measuring IMA might represent a promising marker for early identification of patients with myocardial ischaemia. To assess the role of IMA and its predictive value for early diagnosis of patients with acute coronary syndromes. Seventy three patients with suspected ACS attending the emergency department at Assiut university hospital were included in addition to -sex and age matched -20 healthy control subjects. All patients were presented within 6h of the typical chest pain episode with negative troponin and normal serum albumin levels. Any patient with liver diseases, renal failure, anaemia, malignancy, acute infections, peripheral vascular diseases, cerebral ischaemia and physical exercise within the last 48 hours was excluded. Full history, clinical examination and standard 12 lead ECG, laboratory investigations including CPK, IMA, CRP, lipogram, kidney and liver functions were done. Twenty two patients were diagnosed as non ischaemic chest pain [NICP] and 51 cases as ACS. CPK and troponin levels were normal in all groups at presentations but 6 hours later CPK levels were significantly higher in ACS patients if compared with NICP or control groups [p<0.000]. on the other hand, IMA levels were statistically significantly high in ACS group only [p<0.000] with a good negative predictive value to diagnose NICP [86.3%]. Moreover, IMA levels were statistically significantly higher in patients finally diagnosed as unstable angina [UA] than those who diagnosed as non ST elevation myocardial infarction [NSTEMI] [p<0.04] meanwhile, it is insignificantly higher than that in STEMI patients. The sensitivity of IMA to predict ACS cases [94.1%] was higher than that of ECG [78.4%] and CPK at presentation [14.7%] and after 6 hours [54.7%]. On the other hand, the specificity of IMA, ECG, CPK at presentation and 6 hours later [86.4%, 90.9%, 86.4% and 97% respectively]. IMA can be used at the emergency setting to exclude the diagnosis of ADS. Moreover, the use of IMA as a diagnostic biomarker in addition to standard markers of myocardial injury is very useful for the evaluation of patients with suspected ACS