The efficiency of cardiac biomarkers in the identification of patients with acute coronary syndrome
Background and objective: This study aimed to differentiate acute myocardial infarction from unstable angina upon the onset of chest pain, by evaluating the usefulness of combined biomarkers troponin I, ischemia modified albumin, and heart-type fatty acid binding protein as early as possible.
Methods: A cross-sectional study was conducted at the Department of Clinical Analysis, College of Pharmacy, Hawler Medical University. This study included 73 patients with suspected acute coronary syndrome, who attended to the Emergency and /or Cardiac Care Unit departments of Hawler Teaching Hospital and Rojhalat Emergency Hospital, Erbil, Iraq, and who were diagnosed with either acute myocardial infarction (n=45) or unstable angina (n=28) between 12 May 2013 and 25 January 2014. Serum troponin I, heart-type fatty acid binding protein, and ischemia modified albumin were determined twice, at between 30 minutes and 4 hours, and between 6 and 12 hours after the onset of chest pain.
Results: For diagnosing and differentiating between acute myocardial infarction and unstable angina, the sensitivity and specificity of serum troponin I cut-off value at (≤4) hours of chest pain was 53.3% and 100%, respectively. The sensitivity and specificity were 97.8% and 96.4 at 6-12 hours after onset of chest pain. The sensitivity and specificity of heart-type fatty acid binding protein cut-off values at (≤4) hours was 48.9% and 100%, respectively, increasing to 84.4% and 100% at 6-12 hours. The combined use of serum troponin I and heart-type fatty acid binding protein enhanced sensitivity to 73.3% at the first interval, and 100% at the second.
Conclusion: A combination of troponin I and heart-type fatty acid binding protein tests improves sensitivity in diagnosing and differentiating acute myocardial infarction and unstable angina within the first 4 hours of chest pain.
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