Compairing the value of pregnancy-associated plazma protein a (papp-a) and iskemia modified albumin in the patients with chest pain

Objectives: Early diagnosis in the chest pain patients is very important for the mortality. Troponin and CK-MB are current biochemical parameters which are used for diagnosis of ACS. But troponin and CK-MB are usually not elevated within the first hours after symptom onset. For this reason, the physicians need new biomarkers for early diagnosis of ACS. A good deal of studies has proven that PAPP-A and IMA can be employed as diagnostic parameters especially in early diagnosis of ACS. The purpose of this study is, to compare the diagnostic value of PAPP-A and IMA with each other and the levels of troponin T and CK-MB of the patients admitted to the hospital with chest pain. However further studies are still needed on this subject. Method: Patients applied to the Karadeniz Technical University Medical Faculty Emergency Department with chest pain between January and June 2011 were enrolled in -this single-center, prospective, clinical study. Examination and laboratory findings (troponin-T, CK-MB, PAPP-A, IMA) within the diagnostic algorithm for the chest pain patients belonging to the patients applying to the emergency department were recorded by using standard data forms. Our study group of 152 cases was divided into groups with regard to the initial findings of ECG and the definitive diagnosis. At the end of the study the levels of troponin-T, CK-MB, PAPP-A and IMA in the different groups were compared. Findings: We studied with 152 patients (50.66±18.13 years, 109 men, 43 males) who were admitted to our department with typical and atypical chest pain. According to the initial ECG findings; there were 13 patients with STEMI, 53 patients with NSTEMI/UAP and 80 patients with non-specific ECG findings. When we consider the definitive diagnosis; there were 8 patients with STEMI, 36 patients with NSTEMI, 23 patients with UAP, 17 patients with SAP and 68 patients with non-coroner chest pain. In our study, there were no distinctiveness for the parameters; Troponin T, CK-MB, IMA and PAPP-A in the first four hours. Troponin-T and CK-MB were especially elevated after 4 hours in MI. On the other hand, this study does not support the use of IMA and PAPP-A as a positive predictor of ACS. In this study, sensitivity, specificity, positive predictive value and negative predictive value were calculated for troponin T, CK-MB, IMA and PAPP-A within first four hours. ROC curves were plotted to determine the highest level of specificity at the highest level of sensitivity (%100) in the first 4 hours (0-2 hour, 2-4 hour). In our study, the most specific parameter at the highest sensitivity for the patients with the chest pain within the first hours (0-2 hour, 2-4 hour) was IMA. (Sensitivity/specificity; 100/30.7, 93.7/52.3 respectively). According to our study, IMA was not an ideal marker as a screening test for the evaluation of chest pain in first hours.. However, comparing to troponin T, CK-MB and PAPP-A, IMA was proved as a more useful marker as a screening test in detecting ACS during the first hours. Conclusion: According to our results, PAPP-A and IMA cannot be used as an diagnostic tool like troponin-T and CK-MB in ACS. Our results tell that concerning the characteristics of sensitivity and specificity IMA cannot be used as an ideal screening test in the diagnosis of ACS during the early period of chest pain. Still, IMA is more useful diagnostic biochemical marker than troponin-T, CK-MB and PAPP-A as a screening test in detecting ACS during the first hours. Our study results exhibit contrast to a lot of similar research in the literature, and its findings should be evaluated with wider series of studies. Keywords: PAPP-A, IMA, Chest Pain, Acute Coronary Syndrome.