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Chest pain is the second most common emergency department presentation complaint.1 About one in five chest pain patients will ultimately be diagnosed with an acute coronary syndrome (ACS).2 Most clinical guidelines address how to rule in ACS, yet rule out is a bigger clinical problem in the emergency department.
The Albumin Cobalt Binding (ACB®) Test is a clinical chemistry assay that detects Ischemia Modified Albumin (IMA®) by measuring the cobalt binding capacity of albumin in a patient serum sample. First identified in the early 1990s, IMA is produced when circulating albumin comes in contact with ischemic tissue in the heart. During ischemia, the N-terminus of albumin is altered through a series of chemical reactions that cause free radical damage to albumin. This altered albumin is produced continually during ischemia. IMA concentrations in blood rise quickly and remain elevated during an ischemic event, returning to normal level several hours after cessation of ischemia. IMA can be used in conjunction with electrocardiogram (ECG) and troponin as an aid to rule out ACS at presentation-saving time, resources and money.
IMA speeds risk stratification of patients
IMA is indicated for use in patients who present to the emergency department with:
- Chest pain or symptoms suggestive of cardiac origin
- Low risk for ACS
- Normal or non-diagnostic ECG
- Normal troponin at presentation draw
A negative IMA is used as an aid for short term risk stratification of ACS in such patients. The combination of IMA, ECG and troponin has a higher negative predictive value than any other test or combination of tests.
References
1. McCaig LF, Ly N. National Hospital Ambulatory Medical Care Survey: 2000 Emergency Department Summary. Advance data from vital and health statistics; no. 326. Hyattsville, Maryland: National Center for Health Statistics. 2002.
2. Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. NEJM 2002;342:1163-1170.
3. Pollack CI, Peacock WF, Summers RW, et al. IMA is useful in risk stratification of ED chest pain patients. Acad Emerg Med 10: 555-b-556-b.
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