Scholarlink

Background <p>Rapid and accurate diagnosis of ischemic heart disease (IHD) in patients presenting with acute chest pain remains a critical clinical challenge. Conventional biomarkers such as creatine kinase-MB (CK-MB) and troponins detect myocardial necrosis, not ischemia, potentially delaying diagnosis by hours from symptom onset. Novel biomarkers including ischemia-modified albumin (IMA) and oxidative stress markers [advanced oxidation protein products (AOPP) and modified AOPP (mAOPP)] may enable earlier detection of myocardial ischemia before the completion of necrosis.</p> Methods <p>This prospective cross-sectional diagnostic accuracy study included 165 consecutive patients presenting to the emergency department with acute chest pain between March 2013 and February 2014. Participants were classified as ischemic heart disease (IHD; <i>n</i> = 92) or non-IHD chest pain (<i>n</i> = 73) by two independent cardiologists using clinical history, electrocardiographic findings, and reference cardiac biomarkers according to American Heart Association criteria. Within the IHD group, 50 patients had myocardial infarction and 42 had non-myocardial infarction ischemic presentations (stable angina, <i>n</i> = 20; unstable angina, <i>n</i> = 22). Serum AOPP, mAOPP, IMA, and CK-MB were measured using standard spectrophotometric or immunoenzymatic methods, and diagnostic thresholds for AOPP, mAOPP, and IMA were derived from receiver operating characteristic analysis using the Youden index.</p> Results <p>mAOPP demonstrated the highest sensitivity (79.35%, 95% CI: 69.64–87.08), which was significantly higher than IMA (60.87%, <i>p</i> = 0.001), AOPP (68.48%, <i>p</i> = 0.002), and CK-MB (55.68%, <i>p</i> &lt; 0.001) for detecting IHD. Conversely, IMA demonstrated the highest specificity (95.89%, 95% CI: 88.46–99.14), positive predictive value (94.91%), and positive likelihood ratio (14.81), significantly superior to mAOPP, AOPP, and CK-MB (all <i>p</i> &lt; 0.05). mAOPP showed the lowest negative likelihood ratio (0.26), providing superior exclusionary capacity when negative. Area under the receiver operating characteristic curve values were mAOPP 0.854 (95% CI: 0.795–0.913), AOPP 0.829 (95% CI: 0.767–0.891), IMA 0.821 (95% CI: 0.756–0.886), and CK-MB 0.740 (95% CI: 0.663–0.818), all statistically significant (<i>p</i> &lt; 0.001). A positive IMA result increased the probability of IHD from a baseline 54% to 95%, while mAOPP, AOPP, and CK-MB increased post-test probability to 81–84%.</p> Conclusions <p>IMA, AOPP, and mAOPP demonstrated excellent discriminatory capacity for diagnosing IHD in acute chest pain patients, with overall diagnostic performance superior to the conventional marker CK-MB. The complementary diagnostic roles identified—mAOPP optimized for screening and disease exclusion, and IMA optimized for diagnostic confirmation—suggest that their combined use may improve chest pain evaluation in emergency department settings. A dual-marker diagnostic strategy leveraging the high sensitivity of mAOPP for initial case identification and the exceptional specificity and post-test probability shift of IMA for diagnostic confirmation may improve the efficiency and accuracy of emergency department triage for acute coronary syndromes.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

mAOPP Improves Diagnostic Discrimination of Ischemic Heart Disease Compared with CK-MB and Ischemia-Modified Albumin

  • 期刊论文

  • 发表日期：

    2026年6月19日

查看全文
  • S. S. Avinash,
  • Arbind Kumar Choudhary,
  • K. Arunkumar,
  • Prabin Shah,
  • D. S. Maitreyee,
  • Shailaja A. Katti

摘要

Background

Rapid and accurate diagnosis of ischemic heart disease (IHD) in patients presenting with acute chest pain remains a critical clinical challenge. Conventional biomarkers such as creatine kinase-MB (CK-MB) and troponins detect myocardial necrosis, not ischemia, potentially delaying diagnosis by hours from symptom onset. Novel biomarkers including ischemia-modified albumin (IMA) and oxidative stress markers [advanced oxidation protein products (AOPP) and modified AOPP (mAOPP)] may enable earlier detection of myocardial ischemia before the completion of necrosis.

Methods

This prospective cross-sectional diagnostic accuracy study included 165 consecutive patients presenting to the emergency department with acute chest pain between March 2013 and February 2014. Participants were classified as ischemic heart disease (IHD; n = 92) or non-IHD chest pain (n = 73) by two independent cardiologists using clinical history, electrocardiographic findings, and reference cardiac biomarkers according to American Heart Association criteria. Within the IHD group, 50 patients had myocardial infarction and 42 had non-myocardial infarction ischemic presentations (stable angina, n = 20; unstable angina, n = 22). Serum AOPP, mAOPP, IMA, and CK-MB were measured using standard spectrophotometric or immunoenzymatic methods, and diagnostic thresholds for AOPP, mAOPP, and IMA were derived from receiver operating characteristic analysis using the Youden index.

Results

mAOPP demonstrated the highest sensitivity (79.35%, 95% CI: 69.64–87.08), which was significantly higher than IMA (60.87%, p = 0.001), AOPP (68.48%, p = 0.002), and CK-MB (55.68%, p < 0.001) for detecting IHD. Conversely, IMA demonstrated the highest specificity (95.89%, 95% CI: 88.46–99.14), positive predictive value (94.91%), and positive likelihood ratio (14.81), significantly superior to mAOPP, AOPP, and CK-MB (all p < 0.05). mAOPP showed the lowest negative likelihood ratio (0.26), providing superior exclusionary capacity when negative. Area under the receiver operating characteristic curve values were mAOPP 0.854 (95% CI: 0.795–0.913), AOPP 0.829 (95% CI: 0.767–0.891), IMA 0.821 (95% CI: 0.756–0.886), and CK-MB 0.740 (95% CI: 0.663–0.818), all statistically significant (p < 0.001). A positive IMA result increased the probability of IHD from a baseline 54% to 95%, while mAOPP, AOPP, and CK-MB increased post-test probability to 81–84%.

Conclusions

IMA, AOPP, and mAOPP demonstrated excellent discriminatory capacity for diagnosing IHD in acute chest pain patients, with overall diagnostic performance superior to the conventional marker CK-MB. The complementary diagnostic roles identified—mAOPP optimized for screening and disease exclusion, and IMA optimized for diagnostic confirmation—suggest that their combined use may improve chest pain evaluation in emergency department settings. A dual-marker diagnostic strategy leveraging the high sensitivity of mAOPP for initial case identification and the exceptional specificity and post-test probability shift of IMA for diagnostic confirmation may improve the efficiency and accuracy of emergency department triage for acute coronary syndromes.