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Abstract
Coronary artery disease is the leading cause of death
among adults and one of the most common reasons for ED
visits worldwide.
Acute coronary syndrome refers to a constellation of
clinical symptoms caused by acute myocardial ischemia.
Establishing a diagnosis of ACS in the clinical setting remains
a challenging task. This might be due to the variable nature of
chest pain and different time intervals that pass before
circulating levels of biomarkers of myocardial necrosis are
detected. Although biomarkers of cardiac necrosis such as
troponin and CK-MB have proven to be extremely reliable for
the identification of AMI, they have a limited ability in
identifying patients with myocardial ischemia. Such markers
require serial measurements at least two to six hours after chest
pain onset.
Therefore, there is a desperate need for an early and
sensitive marker for detection of cardiac ischemia in order to
save the myocardium from necrosis. A candidate marker for
detection of myocardial ischemia is ischemia modified albumin.
Measurement of IMA is based on the premise that oxidative
stress conditions such as myocardial ischemia release free
oxygen radicals which lead to reduction in the binding capacity
of human serum albumin to transition metals particularly cobalt.In this regard, our study aimed to evaluate the role of
serum ischemia modified albumin as an early marker for
diagnosis of acute coronary syndrome in patients presenting
with acute chest pain in comparison to other cardiac markers
including total CK, CK-MB and cTnI.Our study was conducted on 50 patients who presented to
the ED with acute chest pain and according to the final
discharge diagnosis they were diagnosed to have ACS. The
patients’ group included 22 patients with UA and 28 patients
with AMI. AMI patients were reclassified into 19 patients with
STEMI and 9 patients with NSTEMI. In addition, 25 healthy
control subjects were included as controls. Subjects with
hypoalbuminemia were excluded from our study.All patients included in this study were subjected to full
medical history, clinical examination, routine laboratory
investigations including renal function tests, liver function tests
and biomarkers of myocardial necrosis (CK, CK-MB and cTnI).
In both patients and control subjects IMA was measured by
albumin cobalt binding in which modifications in the amino
terminal part of HSA are demonstrated by addition of a known
amount of cobalt (II) to a serum specimen and measurement of
the unbound cobalt (II) by colorimetric assay.