The Diagnostic Efficacy of a Triple Prediction Test including Ischemia-Modified Albumin in Ruling Out Acute Coronary Syndrome

ABSTRACT

PURPOSE: In emergency departments (ED), the treatment of acute coronary syndrome (ACS) should be rapid and result from comprehensive diagnostic evaluation. There are increasing needs for supplies in the ED both for monitoring patients and for follow-up diagnostic measures to rule out ACS. The purpose of this study was to determine the effectiveness of a triple prediction test including Ischemia-modified albumin (IMA) as a tool for promptly ruling out ACS in lower-risk patients in ED. METHODS: Between September 2005 and July 2006, we analyzed patients with acute chest pain who were older than 28 years, who visited the ED within 3 hours from the last onset of chest pain, and who had normal or non-diagnostic electrocardiograms (ECG). The triple prediction test was defined as a nondiagnostic ECG, negative cardiac markers (creatine kinase-MB, troponin I), and a lower cutoff value for IMA. RESULTS: We analyzed 149 patients (male female=105 44) whose mean age was 57.9+/-12.1 years. Thirty-two patients fell into IMA-negative group and 117 patients were in the IMA-positive group was 117 patients. There was no difference in sex, age, serum albumin level and medical history between groups. The area under the ROC curve was 0.640. At an IMA cutoff value of 85 U/ml, patients without ACS were negative (below the cutoff value) 4.0 times more than patients with ACS by ROC curve analysis. CONCLUSION: In ruling out ACS, triple predictive test including cardiac markers, ECG, and IMA had insufficient efficacy in the ED. Further studies warranted to reveal IMA is a clinical useful diagnostic test to rule out ACS.