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From the Department of Emergency Medicine, Hamilton Health Sciences (Worster, Opie); the Department of Medicine (Worster, Devereaux, Guyatt), Clinical Epidemiology and Biostatistics (Worster, Devereaux, Heels-Ansdell, Guyatt, Mookadam) and Pathology and Molecular Medicine (Hill), McMaster University; and the Hamilton Regional Laboratory Medicine Program (Hill), Hamilton, Ont.
Correspondence to: Dr. Stephen Hill, Laboratory Medicine, Hamilton General Hospital, 237 Barton St. E, Hamilton, ON L8L 2X2; fax 905 577-8028; hillstev{at}hhsc.ca
Background: Ischemia-modified albumin (IMA) has been suggested as a marker of cardiac ischemia. Little, however, is known about its capacity to predict short-term serious cardiac outcomes (death, myocardial infarction, congestive heart failure, serious arrhythmia, or refractory ischemic cardiac pain) in patients arriving at the emergency department with symptoms that may indicate cardiac ischemia.
Methods: We screened 546 patients over a 4-week period, of whom 189 fulfilled our entry criteria by presenting to an emergency department with potential cardiac-ischemia symptoms within 6 hours after chest pain, seeing an emergency physician who chose to order a troponin I test, and having no serious cardiac outcome before the troponin result became available. We followed the study patients for 72 hours to determine if any experienced a serious cardiac outcome. We calculated the likelihood ratios (LRs) of IMA findings predicting serious cardiac outcomes that could not be diagnosed at presentation with current techniques.
Results: Of the 189 patients, 24 had a serious cardiac outcome within 72 hours after their arrival at the emergency department. The likelihood ratios for IMA measurement within 6 hours after chest pain predicting a serious cardiac outcome within the next 72 hours were 1.35 (95% confidence interval [CI] 0.315–5.79) for IMA 
80 U/mL and 0.98 (95% CI 0.86– 1.11) for IMA > 80 U/mL.
Conclusions: These data suggest that in patients presenting with chest pain who have not yet experienced a serious cardiac event, IMA is a poor predictor of serious cardiac outcomes in the short term.
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