The Value Of Ischemia Modified Albumin In Early Diagnosis Of Acute Coronary Syndromes

Objective:To investigate the early diagnostic value of ischemia modified albumin(IMA)in early diagnosis of acute coronary syndromes.Methods:At first we set up an animal model for myocardial ischemia reperfusion.Through these animal experiments,We can observed the change trend of ischemia modified albumin in the whole process of the myocardial ischemia.And the variation laws were observed by measuring IMA,CK,CK-MB,MYO and cTnI of 277 patients with symptoms of acute chest pain in 3 hours after their admission in emergency department. Of the 277 patients,there are 226 patients who are diagnosed as ACS through coronary artery PCR later,and 51 patients were excluded from ACS.At the same time,we chose 202 healthy people who come to our hospital to take the body check-up and measure the IMA values of their serum as contrast.We took the albumin cobalt binding(ACB)test measure the IMA,and take the ACB value as the result to report.The descending ACB value meant a raised IMA value.Result:Data from the animal experiments showed that the IMA were produced and kept to raise which led to the ACB descended when the myocardial ischemia took place in the animals,and few hours later the ACB value would raise.We also can make out the rule curve of ischemia modified albumin,and validate the output in our clinical experiments subsequently.We make out the relative operating characteristic curve(ROC curve)based on the data got from the tests.From the ROC curve we know that when the cut off value of ACB is 67.6U/mL,the summation of the sensitivity value and the specificity value in ACB test is the greatest.So to our test,67.6U/mL is the best cut off value with the highest diagnostic efficiency and the lowest mistakes.When the cut off value of ACB is 67.6U/mL,the area under the ROC curve is 0.882,the sensitivity value is 90.7%and the specificity value is 68.6%.Of the 226 patients who are diagnosed as ACS, there are 205 patients whose ACB value descended and were lower than the cut off value.Its positive rate is 90.7%,and the positive rate of CK,CK-MB,MYO and cardiac troponin are 19.5%,32.7%,16.8%and 46.5% respectively.There are obvious variation between IMA and the other four myocardial markers when the myocardial ischemia take place in a few hours(X~2=318.901,P＜0.01).And the ACB values of the ACS group are obvious lower than the Healthy contrast group(t=-33.560,P＜0.01)and the non-ACS group(t=-10.024,P＜0.01).When are associated with IMA, the positive rate of the other four myocardial markers in denoting the early myocardial ischemia all rise to 90%above.Conclusions:Ischemia modified albumin(IMA)can get into being rapidly and run into the blood circulation once the myocardial ischemia take place,and the ACB test can measure the IMA value exactly and rapidly.IMA maybe an earlier maker of myocardial ischemia than the other four myocardial markers,It may applied in an early diagnosis of acute coronary ischemia,and will improve the early diagnostic sensitivity of ACS significantly.