Ischemia modified albumin in patients with acute cardiac ischemia

Differentiating transient myocardial ischemia or angina from non-cardiac causes of chest pain is a major diagnostic challenge. Cardiac troponin I [cTnI] is sensitive and specific for the detection of myocardial damage but may not rise during reversible myocardial ischemia. Ischemia Modified Albumin [IMA] has recently been shown to be a sensitive and early biochemical marker of ischemia. We studied eighty-five patients presenting to the emergency department [ED] within 3 hours of acute chest pain. Blood samples were taken for IMA and cardiac troponin I, at presentation and then after 12 hours. Patients underwent standardized diagnostic procedures, and treatment. Results of IMA, cTnI were correlated with final diagnoses of non-ischaemic chest pain [NICP], unstable angina [UA] and acute myocardial infarction [AMI]. The sensitivity and specificity of IMA for the detection of myocardial ischemia were evaluated by ROC curve analysis. The mean absorbance value [ABSU] of IMA was significantly higher in patients with UA [0.6610.14 and 0.70 +/- 0.18] and those with AMI [0.70 +/- 0.19 and 0.74 +/- 0.22] when compared to individuals with NICP [0.48 +/- 0.11 and 0.50 +/- 0.13] [p < 0.001], both at admission and at the late 12 hours samples respectively. However, the mean ABSU value of IMA showed no significant difference between patients with UA and AMI [P > 0.05] both at admission and after 12 hours. When ROC curve was constructed to evaluate IMA-ABSU in NICP patients compared to all acute coronary syndrome [ACS] patients, the area under the curve was 0.85 [95% confidence interval [CI], 0.76-0.94], immediately after admission, and at cutoff value of 0.51 ABSU, sensitivity and specificity were 86% and 64% respectively. Nearly, the same results were obtained when NICP patients was compared with AMI patients and UA patients separately. While when we compared UA and AMI groups, the area under the curve was 0.6 [95% confidence interval [CI], 0.45-0.74], indicating a poor discrimination between these two groups. CTnI values showed a non-significant difference between patients with UA [1.6 +/- 0.7mnicrog/L] and NICP [1.3 +/- 0.3 microg/L], [P>0.05] at the time of admission, but after 12 hours, cTnI values were significantly higher in patients with UA [1.8 +/- 0.6microg/L] than NICP [1.3 +/- 0.5 microg/L], [P < 0.05]. On the other hand, patients with AMI showed significant increase of cTnI both at admission [1.8 +/- 0.8 microg/L] and 12 hours later [2.9 +/- 0.9 microg/L] when compared to NICP group [p < 0.01 and 0.001 respectively]. IMA is highly sensitive for the early diagnosis of myocardial ischemia in patients presenting with symptoms of acute chest pain

IV Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention

The rapid progress in the field of interventional cardiology in the last few years necessitates a continuous search for the most safe and effective methods to gain an optimum results, either equipments or drugs. to examine the use of enoxaparin as an anticoagulant in elective PCI, and compare it with unfractionated heparin regarding the acute procedural complications and the immediate 24-hour post-PCI events. The study was conducted on 84 patients who were classified independently into 2 groups. 50 patients represent group [A], received IV single bolus of enoxaparin in a dose of 0.5mg/kg at the start of the procedure and 34 patients represent group [B], received the usual traditional dose of unfractionated heparin [10000-15000 units].All patients were prepared by clopidogrel or ticlopidin before PCI in addition to aspirin 150 mg daily.Follow up was done for all patients during the immediate 24 hours after PCI for death, myocardial infarction, myocardial ischemia requiring urget coronary intervention and cerobrovascular stroke. There was no statistical significant difference between the two groups regarding the type of vessels treated or number of stents placed. None of the patients of both groups experienced any of the following complications during the procedure or 24 hours after: major bleeding, myocardial infarction, myocardial ischemia requiring urgent surgical or repeat percutaneous coronary revascularization or death. The major difference between the two groups was the immediate sheath removal in the enoxaparin group, without sheath site complication [minor haematoma] which was observed in 9% of the UFH group. Angiographic complications were coronary artery dissection [in one patient in group A [2%] and 3 patients in group B [9%]] and acute closure of the culprit vessel [occurred in one patient in group A [2%] and none in group B. The results were quite encouraging, with no statistical differences between the two arms of the study regarding the acute complications and the clinical outcome. The use of enoxaparin in this reduced dose is feasible in elective PCI with adequate level of anticoagulation without need for monitoring its anticoagulant effect. The early sheath removal in group A necessitates further studies to assess its impact on the duration of hospital stay and the possibility of early discharge of the patients