Thanks Ian,
I have no direct experience of IMA so perhaps should keep quiet, but it
occurs to me that if your data is correct, that presumably means the test
can be used to exclude roughly 50% of patients with TnT negative chest pain
from attending follow-up clinics. I am sure some managers will find the test
very helpful with their budgets. IMA could become the next great demand
management tool providing considerable cost and time saving to clinicians.
Even better I think. If the actual test results themselves don't matter,
standardisation, imprecision and inaccuracy aren't important. Though I am
sure we should still do our best to minimise them! Opinions welcome on that
point.
(You could of course adjust the 50% figure to any other percentage just by
changing the cut-off value.)
It sounds great! Kudos points to any committees that can help generate
demand for IMA.
Regards
Steve
ps The views expressed are entirely my own and are unlikely to have any
scientific validity.
-----Original Message-----
From: Ian Godber [mailto:[log in to unmask]]
Sent: 21 November 2006 15:56
To: [log in to unmask]
Subject: Re: IMA - why are we measuring it?
Further to Sean's email, amongst those who've looked at IMA, what is the
general consensus on it's clinical utility??
In 2004 we looked at it on the Beckman LX20 in patients presenting <12
hours following onset of chest pain (n=160) to see if it distinguished
patients later classified with chest pain due to either ischaemic (n=41) or
non-ischaemic causes (n=86).
All our patients with chest pain had an ECG, and were tested for IMA and
cTnT on admission. We found no significant difference was seen between the
patients with suggestive ischaemia and those with non-cardiac causes
(p=0.5092).
The only difference we saw was between the patients with TnT positive
cardiac chest pain and 'normal' individuals. This difference can already be
established using TnT. A linear relationship was seen between albumin and
IMA, where a low albumin correlated to a raised IMA result, thus
complicating the interpretation of IMA and requires further work,
a link between an APR and IMA was ruled out though.
This was presented as a poster at EuroMedLab in Glasgow (Todd et all, Clin
Chem Acta 355(s): p105). It'd be interested to see what others have found
and if anyone's using it in clinical practice.
Ian
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