Meta-analysis of ischemia-modified albumin to rule out acute coronary syndromes in the emergency department.


Journal Article

BACKGROUND: Because of possible adverse outcomes, many of the >6 million annual emergency department (ED) patients with suspected acute coronary syndromes (ACS) undergo extensive evaluations. To minimize medical errors, chest pain evaluations are structured to identify accurately nearly 100% of patients with ACS. This is at a cost of negative evaluation rates that can exceed 90%. Ischemia-modified albumin (IMA), a serum biomarker with a high negative predictive value (NPV) at ED presentation, may exclude ACS. Our objective was to perform a meta-analysis of IMA use for ACS risk stratification. METHODS: By computer literature search and communication with authors of unpublished information, all IMA data were considered. This analysis included studies if they reported IMA results from an ED presentation for suspected ACS. We defined a negative triple prediction test (TPT) as a nondiagnostic electrocardiogram, negative troponin, and negative IMA. RESULTS: Eight studies of >1800 patients met the entry criteria. The TPT sensitivity and NPV for acute ACS were 94.4% and 97.1% and, for longer-term outcomes, were 89.2% and 94.5%, respectively. CONCLUSIONS: A negative TPT of a nondiagnostic electrocardiogram, negative troponin, and negative IMA has a high NPV for excluding ACS in the ED.

Full Text

Duke Authors

Cited Authors

  • Peacock, F; Morris, DL; Anwaruddin, S; Christenson, RH; Collinson, PO; Goodacre, SW; Januzzi, JL; Jesse, RL; Kaski, JC; Kontos, MC; Lefevre, G; Mutrie, D; Sinha, MK; Uettwiller-Geiger, D; Pollack, CV

Published Date

  • August 2006

Published In

Volume / Issue

  • 152 / 2

Start / End Page

  • 253 - 262

PubMed ID

  • 16875905

Pubmed Central ID

  • 16875905

Electronic International Standard Serial Number (EISSN)

  • 1097-6744

Digital Object Identifier (DOI)

  • 10.1016/j.ahj.2005.12.024


  • eng

Conference Location

  • United States