Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity

EREL, Ozcan; NEŞELİOĞLU, Salim; Yuksel Kalkan, Gulhan; özbiçer, süleyman; Urgun, Örsan Deniz

doi:10.17826/cumj.976875

Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity

Suleyman OZBİCER, (Sağlık Bilimleri Üniversitesi, Adana Şehir Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Adana, Türkiye)

Gulhan KALKAN, (Sağlık Bilimleri Üniversitesi, Adana Şehir Eğitim ve Araştırma Hastanesi, Kardiyoloji Kliniği, Adana, Türkiye)

Örsan Deniz URGUN, (Kozan Devlet Hastanesi, Kardiyoloji Kliniği, Adana, Türkiye)

Salim NEŞELİOĞLU, (Ankara Yıldırım Beyazıt Üniversitesi, Tıbbi Biyokimya Anabilim Dalı, Ankara, Türkiye)

Özcan EREL (Ankara Yıldırım Beyazıt Üniversitesi, Tıbbi Biyokimya Anabilim Dalı, Ankara, Türkiye)

Cukurova Medical Journal

1 1

Yıl: 2021 Cilt: 46 Sayı: 4 Sayfa Aralığı: 1566 - 1573 Metin Dili: İngilizce DOI: 10.17826/cumj.976875 İndeks Tarihi: 29-07-2022

Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity

Öz:

Purpose: The aim of this study was to investigate the diagnostic value of ischemia modified albumin (IMA) in early non-ST elevation myocardial infarction (NSTEMI) patients diagnosed with high-sensitive cardiac troponin (hs-cTn)assays. Materials and Methods: In the first three hours of symptom onset, one hundred sixty-two patients without cardiovascular disease history admitted to our hospital with NSTEMI were enrolled between March 2018 and August 2019. The patients' IMA levels were compared with IMA levels of randomly selected, age and the sexmatched control group comprised of 61 subjects with normal coronary angiography results. Results: IMA levels of NSTEMI patients were higher than the control group. In receiver operating characteristic (ROC) curve analysis, a value equal or greater than 0.3855 ABSU has an 82% sensitivity and a 99.4% specificity for diagnosing NSTEMI (AUC: 0.962, 95% CI: 0.937 – 0.986,). In addition, ROC curve analysis revealed moderate predictive power for distinguishing three-vessel disease (cut-off value: 0.4290 ABSU, sensitivity 78.4% and specificity 56.3%, AUC: 0.696, 95% CI: 0.616 – 0.776,). IMA levels were positively correlated with Gensini scores of the patient group. Conclusion: Ischemia-modified albumin, when used alone, was very useful in distinguishing NSTEMI from non-ischemic controls. Besides, IMA levels were positively correlated with CAD severity.

Anahtar Kelime: Sulfhydryl Compounds Atherosclerosis Myocardial Infarction

İskemi modifiye albümin düzeylerinin NSTEMI hastalarını iskemik olmayan kontrollerden ayırt etmedeki rolü ve hastalık şiddeti ile ilişkisi

Öz:

Amaç: Bu çalışmada yüksek duyarlılığa sahip kardiyak troponin (hs-cTn) testleri ile tanı konulan erken dönem ST yükselmesiz miyokard infarktüsü (NSTEMI) hastalarında iskemi modifiye albümin (İMA) 'nın tanısal değerini araştırmayı amaçladık. Gereç ve Yöntem: Mart 2018 ve Ağustos 2019 tarihleri arasında hastanemize NSTEMI ile başvuran kardiyovasküler hastalık öyküsü olmayan 126 hasta kaydedildi. Hastaların IMA düzeyleri rastgele seçilen, yaş ve cinsiyet eşleştirilmiş koroner anjiyografi sonuçları normal olan 61 deneğin IMA düzeyleri ile karşılaştırıldı. Bulgular: NSTEMI hastalarının IMA seviyeleri kontrol grubuna göre daha yüksekti. İşlem karakteristiği (ROC) eğri analizinde, 0,3855 ABSU' ya eşit veya daha büyük bir değer, NSTEMI tanısı için %82 duyarlılığa ve%99,4 özgülüğe sahiptir (EAA: 0,962, %95 CI: 0,937 – 0,986). Ek olarak, ROC eğrisi analizi, üç damar hastalığını ayırt etmek için orta düzeyde tahmin gücü ortaya koydu (sınır değeri: 0,4290 ABSU, duyarlılık %78,4 ve özgüllük %56,3, EAA: 0,696, %95 CI: 0,616 – 0,776). İMA düzeyleri ile hasta grubunun Gensini puanları arasında pozitif korelasyon vardı. Sonuç: İskemi modifiye albümin tek başına kullanıldığında, NSTEMI' yi iskemik olmayan kontrollerden ayırt etmede oldukça yararlı olmuştur. Ayrıca, IMA seviyeleri KAH şiddeti ile pozitif korelasyon gösteriyordu.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P et al. Acute myocardial infarction: changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation. 2017;136:1908-19.
2. Twerenbold R, Badertscher P, Boeddinghaus J, Nestelberger T, Wildi K, Puelacher C et al. 0/1-Hour Triage algorithm for myocardial infarction in patients with renal dysfunction. Circulation. 2018;137:436-51.
3. Boeddinghaus J, Twerenbold R, Nestelberger T, Koechlin L, Wussler D, Meier M et al. Clinical use of a new high-sensitivity cardiac troponin i assay in patients with suspected myocardial infarction. Clin Chem. 2019;65:1426-36.
4. Collet JP, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt DL et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020.
5. Sbarouni E, Georgiadou P, Voudris V. Ischemia modified albumin changes – review and clinical implications. Clin Chem Lab Med. 2011;49:177.
6. Collinson PO, Gaze DC. Biomarkers of cardiovascular damage and dysfunction--an overview. Heart Lung Circulation. 2007;16:71-82. .
7. Keating L, Benger JR, Beetham R, Bateman S, Veysey S, Kendall J et al. The PRIMA study: presentation ischaemia-modified albumin in the emergency department. Emerg Med J. 2006;23:764-8.
8. Hjortshoj S, Kristensen SR, Ravkilde J. Diagnostic value of ischemia-modified albumin in patients with suspected acute coronary syndrome. Am J Emerg Med. 2010;28:170-6.
9. Christenson RH, Duh SH, Sanhai WR, Wu AH, Holtman V, Painter P et al. Characteristics of an Albumin Cobalt Binding Test for assessment of acute coronary syndrome patients: a multicenter study. Clin Chem. 2001;47:464-70.
10. Peacock F, Morris DL, Anwaruddin S, Christenson RH, Collinson PO, Goodacre SW et al. Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department. Am Heart J. 2006;152:253-62.
11. Sinha MK, Roy D, Gaze DC, Collinson PO, Kaski JC. Role of "Ischemia modified albumin", a new biochemical marker of myocardial ischaemia, in the early diagnosis of acute coronary syndromes. Emerg Med J. 2004;21:29-34.
12. Koc F, Erdem S, Altunkas F, Ozbek K, Gul EE, Kurban S et al. Ischemia-modified albumin and total antioxidant status in patients with slow coronary flow: a pilot observational study. Anadolu Kardiyol Derg. 2011;11:582-7.
13. Lippi G, Ferrari A, Gandini G, Gelati M, Lo Cascio C, Salvagno GL. Analytical evaluation of the new Beckman Coulter Access high sensitivity cardiac troponin I immunoassay. Clin Chem Lab Med. 2017;56:157-61.
14. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Rev Esp Cardiol (Engl Ed) 2015;68:1125.
15. Bar–Or D, Lau E, Winkler JV. A novel assay for cobalt-albumin binding and its potential as a marker for myocardial ischemia—a preliminary report. J Emerg Med. 2000;19:311-15.
16. Hosmer DW, Lemeshow S. Applied Logistic Regression. New York, Wiley, 2008.
17. Chek J, Dusek J, Stasek J, Vojacek J, Bis J, Ulrychova M et al. Role of ischemia-modified albumin in estimating the extent and scope of cardiac ischemia in patients with ST elevation myocardial infarction. Heart and vessels. 2011;26:622-7.
18. Dominguez-Rodriguez A, Abreu-Gonzalez P, GarciaGonzalez MJ, Samimi-Fard S, Kaski JC. Relation of ischemia-modified albumin levels and left ventricular systolic function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Clin Chim Acta. 2008;388:196-99.
19. Bali L, Cuisset T, Giorgi R, Monserrat C, Quilici J, Carrega L et al. Prognostic value of ischaemiamodified albumin in patients with non-ST-segment elevation acute coronary syndromes. Arch Cardiovasc Dis. 2008;101:645-51.
20. Bhagavan NV, Lai EM, Rios PA, Yang J, OrtegaLopez AM, Shinoda H et al. Evaluation of human serum albumin cobalt binding assay for the assessment of myocardial ischemia and myocardial infarction. Clin Chem. 2003; 49:581-5.
21. Roy D, Quiles J, Aldama G, Sinha M, Avanzas P, Arroyo-Espliguero R et al. Ischemia Modified Albumin for the assessment of patients presenting to the emergency department with acute chest pain but normal or non-diagnostic 12-lead electrocardiograms and negative cardiac troponin T. Int J Cardiol. 2004;97:297-301.
22. Collinson PO, Gaze DC, Bainbridge K, Morris F, Morris B, Price A et al. Utility of admission cardiac troponin and "ischemia modified albumin" measurements for rapid evaluation and rule out of suspected acute myocardial infarction in the emergency department. Emerg Med J. 2006;23:256- 61.
23. Anwaruddin S, Januzzi JL, Jr., Baggish AL, Lewandrowski EL, Lewandrowski KB. Ischemiamodified albumin improves the usefulness of standard cardiac biomarkers for the diagnosis of myocardial ischemia in the emergency department setting. Am J Clin Pathol. 2005;123:140-5.
24. Demirtas AO, Karabag T, Demirtas D. Ischemic modified albumin predicts critical coronary artery disease in unstable angina pectoris and non-stelevation myocardial infarction. J Clin Med Res. 2018;10:570-75.
25. Duarte MM, Rocha JB, Moresco RN, Duarte T, Da Cruz IB, Loro VL et al. Association between ischemia-modified albumin, lipids and inflammation biomarkers in patients with hypercholesterolemia. Clin Biochem. 2009;42:666-71.
26. Piwowar A, Knapik-Kordecka M, Warwas M. Ischemia-modified albumin level in type 2 diabetes mellitus - Preliminary report. Dis Markers. 2008;24:311-7.
27. Baydin A, Amanvermez R, Tuncel Ö K, Ocak M, Meric M, Cokluk C. Ischemia-modified albumin is not better than creatine kinase-MB and cardiac troponin I in predicting a cardiac injury in nontraumatic subarachnoid hemorrhage. Am J Emerg Med. 2015;33:488-92.
28. Sbarouni E, Georgiadou P, Panagiotakos D, Livanis EG, Theodorakis GN, Kremastinos DT. Ischaemia modified albumin in radiofrequency catheter ablation. Europace. 2007;9:127-9.
29. Hjortshøj S, Dethlefsen C, Kristensen SR, Ravkilde J. Kinetics of ischaemia modified albumin during ongoing severe myocardial ischaemia. Clin Chim Acta. 2009; 403: 114-20.
30. Sinha MK, Gaze DC, Tippins JR, Collinson PO, Kaski JC. Ischemia modified albumin is a sensitive marker of myocardial ischemia after percutaneous coronary intervention. Circulation. 2003;107:2403-5.
31. Sinha MK, Vazquez JM, Calvino R, Gaze DC, Collinson PO, Kaski JC. Effects of balloon occlusion during percutaneous coronary intervention on circulating ischemia modified albumin and transmyocardial lactate extraction. Heart. 2006;92:1852-3.
32. Quiles J, Roy D, Gaze D, Garrido IP, Avanzas P, Sinha M et al. relation of ischemia-modified albumin (IMA) levels following elective angioplasty for stable angina pectoris to duration of balloon-induced myocardial ischemia. Am J Cardiol. 2003;92:322-4.

APA	özbiçer s, Yuksel Kalkan G, Urgun Ö, NEŞELİOĞLU S, EREL O (2021). Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. , 1566 - 1573. 10.17826/cumj.976875
Chicago	özbiçer süleyman,Yuksel Kalkan Gulhan,Urgun Örsan Deniz,NEŞELİOĞLU Salim,EREL Ozcan Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. (2021): 1566 - 1573. 10.17826/cumj.976875
MLA	özbiçer süleyman,Yuksel Kalkan Gulhan,Urgun Örsan Deniz,NEŞELİOĞLU Salim,EREL Ozcan Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. , 2021, ss.1566 - 1573. 10.17826/cumj.976875
AMA	özbiçer s,Yuksel Kalkan G,Urgun Ö,NEŞELİOĞLU S,EREL O Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. . 2021; 1566 - 1573. 10.17826/cumj.976875
Vancouver	özbiçer s,Yuksel Kalkan G,Urgun Ö,NEŞELİOĞLU S,EREL O Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. . 2021; 1566 - 1573. 10.17826/cumj.976875
IEEE	özbiçer s,Yuksel Kalkan G,Urgun Ö,NEŞELİOĞLU S,EREL O "Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity." , ss.1566 - 1573, 2021. 10.17826/cumj.976875
ISNAD	özbiçer, süleyman vd. "Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity". (2021), 1566-1573. https://doi.org/10.17826/cumj.976875

APA	özbiçer s, Yuksel Kalkan G, Urgun Ö, NEŞELİOĞLU S, EREL O (2021). Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. Cukurova Medical Journal, 46(4), 1566 - 1573. 10.17826/cumj.976875
Chicago	özbiçer süleyman,Yuksel Kalkan Gulhan,Urgun Örsan Deniz,NEŞELİOĞLU Salim,EREL Ozcan Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. Cukurova Medical Journal 46, no.4 (2021): 1566 - 1573. 10.17826/cumj.976875
MLA	özbiçer süleyman,Yuksel Kalkan Gulhan,Urgun Örsan Deniz,NEŞELİOĞLU Salim,EREL Ozcan Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. Cukurova Medical Journal, vol.46, no.4, 2021, ss.1566 - 1573. 10.17826/cumj.976875
AMA	özbiçer s,Yuksel Kalkan G,Urgun Ö,NEŞELİOĞLU S,EREL O Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. Cukurova Medical Journal. 2021; 46(4): 1566 - 1573. 10.17826/cumj.976875
Vancouver	özbiçer s,Yuksel Kalkan G,Urgun Ö,NEŞELİOĞLU S,EREL O Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity. Cukurova Medical Journal. 2021; 46(4): 1566 - 1573. 10.17826/cumj.976875
IEEE	özbiçer s,Yuksel Kalkan G,Urgun Ö,NEŞELİOĞLU S,EREL O "Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity." Cukurova Medical Journal, 46, ss.1566 - 1573, 2021. 10.17826/cumj.976875
ISNAD	özbiçer, süleyman vd. "Ischemia modified albumin levels in distinguishing NSTEMI patients from non-ischemic controls and correlation with disease severity". Cukurova Medical Journal 46/4 (2021), 1566-1573. https://doi.org/10.17826/cumj.976875