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Ischemia-modified albumin is a highly sensitive serum marker of transient myocardial ischemia induced by coronary vasospasm.
Coron Artery Dis. 2007 Mar;18(2):83-7.
Cho DK, Choi JO, Kim SH, Choi J, Rhee I, Ki CS, Lee SC, Gwon HC.
aDepartment
of Internal Medicine, Hanmaeum General Hospital, Jeju Departments of
bEmergency Medicine cMedicine dLaboratory Medicine, Samsung Medical
Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
BACKGROUND:
Ischemia-modified albumin, a new marker of myocardial ischemia, is
known to elevate during ischemia induced by percutaneous coronary
intervention. It is, however, not known whether ischemia-modified
albumin also elevates during transient coronary vasospasm.
METHODS: We
evaluated ischemia-modified albumin in patients undergoing
intracoronary ergonovine spasm provocation test (n=26). For additional
comparison, ischemia-modified albumin was also evaluated in elective
percutaneous coronary intervention patients (n=18) and in patients with
normal coronary angiography (n=10). Blood samples were taken from the
arterial sheath before the procedure, just after procedural completion,
or balloon inflation. RESULTS: Median ischemia-modified albumin level
elevated significantly in patients with positive provocation test
compared with baseline [n=16, 106.0 (interquartile range 96.5, 115.5)
versus 128.5 (114.8, 171.8) U/ml, P<0.001], whereas it did not
change in patients with negative provocation test [n=10, 109.5 (103.3,
115.0) versus 113.5 (104.0, 118.3) U/ml, P=0.108]. Ischemia-modified
albumin was also higher after percutaneous coronary intervention [113.5
(101.0, 131.5) versus 151.0 (129.3, 231.0) U/ml, P<0.0001] and did
not change in patients with normal coronary angiography [108.5 (99.3,
114.0) versus 110.0 (108.0, 114.0) U/ml, P=0.085]. Ischemia-modified
albumin elevation higher than 9 U/ml after provocation test could
detect the presence of coronary vasospasm, with an area under the
receiver operating characteristic curve of 0.975 (95% confidence
interval 0.921-1.000), with a sensitivity of 94% and a specificity of
99%. Serum albumin levels were within reference range for all patients
and there was no significant relationship between albumin and baseline
ischemia-modified albumin or postischemic ischemia-modified albumin.
CONCLUSION: Thus, ischemia-modified albumin may have a role as a
biochemical marker for transient myocardial ischemia induced by
coronary vasospasm.
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