Little is known about the capacity of ischemia-modified albumin (IMA) plasma concentration to predict long-term cardiac outcome in patients with established acute myocardial infarction (AMI). Because IMA is a marker of ischemia rather than myocardial cell damage, we hypothesized that IMA plasma levels could provide additional prognostic value to classic clinical and biological risk markers in patients with AMI. Therefore, we investigated the predictive value of plasma IMA in patients with AMI enrolled in the French Nationwide OPERA study.

Plasma concentrations of IMA and other cardiac biomarkers (troponin, C-reactive protein, B-type natriuretic peptide) were measured within 24 hours of hospital admission in 471 patients hospitalized with an AMI (defined using European Society of Cardiology/American College of Cardiology criteria). Patients' characteristics, cardiovascular risk factors and treatments, and clinical outcomes were recorded. Univariate and multivariable predictors of cardiac outcome in-hospital and at 1 year were identified.

The primary composite end point (death, resuscitated cardiac arrest, recurrent myocardial infarction or ischemia, heart failure, stroke) occurred in 75 (15.6%) patients in-hospital and in 144 (30.6%) at 1 year: 40% of patients in the highest IMA quartile (>104 IU/mL) reached the end point compared with 20% in the lowest (<83 IU/mL) by 1 year. Multivariable logistic regression analysis identified 4 independent predictors of composite end point at 1 year: plasma concentrations of IMA (P = .01), brain natriuretic peptide (P = .001), heart failure (P = .005), and age (P = .003).

In patients with AMI, IMA measured within 24 hours is a strong and independent predictor of cardiac outcome at 1 year and may help identify those requiring more aggressive medical management.