Increased Circulatory Levels of Ischemia Modified Albumin, Protein Carbonyl, Malondialdehyde and Total Antioxidant Capacity as Prognostic Biomarkers for Non-ST-segment Elevation Myocardial Infarction: A ROC Curve Analysis

Oxidative stress by cardiac ischemia causes protein modifications in serum albumin to create Ischemia Modified Albumin (IMA) and other circulatory proteins to create protein carbonyl (PC), whose increase from the baseline could be used as a diagnostic tool for cardiac ischemia disease. We aimed to evaluate the differentiation of IMA, PC, malondialdehyde (MDA) and total antioxidant capacity (TAC) between patients with early stage non-ST-segment elevation myocardial infarction (NSTEMI) and healthy control subjects and test their sole and integrative recognition efficiency as rapid predictive biomarkers for NSTEMI. We selected 52 patients of both sexes with the diagnosis of NSTEMI within 6 hours. Fifty-two healthy individuals without significant differences in sex and age having normal cardiac troponin I (cTnI) levels were enrolled as control group. Serum samples were collected and IMA, PC, MDA, and TAC levels were quantified and then, their findings were compared with serum cTnI levels as the "gold standard". Linear regression, correlation, and receiver operating characteristic (ROC) curve analyses showed that both circulatory levels of PC and IMA were statistically elevated in NSTEMI patients compared to control group, and both had statistically high sensitivity and specificity for rapid prediction of NSTEMI. Combinatorial determination of both biomarkers increased the test specificity and negative predictive value (NPV). Both PC and IMA contents could be used as early biomarkers for diagnosis of NSTEMI and integrative determination of both biomarkers could be used in emergency departments for the fast diagnosis of NSTEMI.