Derivation and validation of a sensitive IMA cutpoint to predict cardiac events in patients with chest pain

Alex F. Manini, J. Ilgen, V. E. Noble, F. Bamberg, W. Koenig, J. S. Bohan, U. Hoffmann

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objectives: In patients with acute chest pain, we derived a cutpoint for ischaemia-modified albumin (IMA) and prospectively validated this cutpoint to predict 30-day major adverse cardiac events (MACEs). Methods: We prospectively recruited a derivation cohort (18-month period) to establish a serum IMA cutpoint targeting 80% sensitivity. This was followed by a prospective validation cohort study of emergency department patients with acute chest pain at two university hospitals over a 3-month period. A MACE was defined as myocardial infarction, revascularisation or death at 30-day follow-up. Results: In the derivation cohort of 151 patients, the IMA cutpoint that achieved 80% sensitivity for MACEs was 75 KU/litre. The sensitivity was prospectively validated in 171 patients consecutively enrolled, of whom 106 underwent multiple-biomarker analysis (19.8% MACE rate, 81% sensitivity of IMA). Furthermore, IMA by itself (81%, <,0.01) and in combination with initial highly sensitive cardiac troponin T (hsTnT) (90%, <,0.001) had significantly higher sensitivity than initial hsTnT (29%) for prediction of MACEs. Conclusions: We prospectively validated the sensitive IMA cutpoint of 75 KU/litre with 80% sensitivity for MACEs in patients with acute chest pain. Our data suggest that IMA alone and in combination with initial hsTnT are more sensitive than the initial hsTnT for MACEs.

Original languageEnglish
Pages (from-to)791-796
Number of pages6
JournalEmergency Medicine Journal
Volume26
Issue number11
DOIs
StatePublished - Nov 2009

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