Ischemia-modified albumin: Is it a promising marker in acute coronary syndrome?

Abstract

Background Acute coronary syndrome (ACS) is a type of coronary heart disease (CHD), which is responsible for one-third of total deaths in people older than 35 years. Even though cardiac troponin is the gold standard for myocardial necrosis it is blind for ischemia without necrosis. Studies demonstrate that IMA is more sensitive in diagnosing ischemic chest pain compared to cardiac troponin T and electrocardiogram, and its combination with these tests significantly increases the sensitivity for diagnosing unstable angina, NSTEMI, or STEMI, with high positive and negative predictive values, making it a valuable tool for ruling out ACS in patients with inconclusive diagnoses in the emergency department. Methods and Findings This prospective cohort study, conducted at the Teaching Hospital, Peradeniya, Sri Lanka, from 2015 to 2019, investigated ischemia-modified albumin (IMA) levels in 330 acute coronary syndrome (ACS) patients. Excluding those with various chronic conditions and those on specific medications, serum IMA was analysed using a colorimetric assay based on cobalt (II) binding to human serum albumin affected by myocardial ischemia. The study found a significant right skew in IMA distribution, confirming its non-normality. No overall significant gender-based difference in IMA levels was observed, though within the younger age group (< 59 years), males exhibited higher IMA concentrations than females. Ethnicity and age appeared to have limited impact on IMA levels. Notably, a significant gender difference in IMA levels was found in obese patients, suggesting physiological differences in response to obesity. The study also revealed higher IMA concentrations in NSTEMI and STEMI patients compared to those with unstable angina. A significant positive correlation between serum IMA levels and lipid profiles, particularly LDL-cholesterol, was established, indicating a link with dyslipidaemia. Conclusion The findings suggest the potential of IMA as a multifaceted biomarker in ACS diagnosis and prognosis, emphasizing the need for personalized medicine approaches and highlighting the role of lipid management in ACS risk reduction.