Heart-type fatty acid-binding protein may exclude acute myocardial infarction on admission to emergency department for chest pain

Abstract

Chest pain is one of the most frequent reasons for presentation to the emergency department (ED), although the estimated prevalence of AMI (acute myocardial infarction) in the ED is about 4%. One criterion for diagnosis of AMI is the demonstration of a rise and/or fall in cardiac troponins, but time is needed for this to happen. Thus, the use of an additional 'early marker' of cardiac injury may aid to exclude AMI rapidly. The aim of the study was to evaluate the possibility of excluding AMI with the determination of heart-type fatty acid-binding protein (H-FABP) on baseline samples of patients referring to the ED for chest pain. 26 AMI patients and 41 non-AMI comparisons were included in the study. Both H-FABP and high sensitivity cardiac troponin T (hs-cTnT) were measured in baseline samples from these subjects. H-FABP had a negative predictive value of 100%, thus indicating the possibility of its usage in a rule-out strategy for AMI in ED for patients presenting with chest pain.

Heart-type fatty acid binding protein in early diagnosis of myocardial infarction in the era of high-sensitivity troponin: a systematic review and meta-analysis

“…18 Four studies had a prospective design, 15,[20][21][22] while the rest performed retrospective analyses of frozen plasma samples. Three studies used hsTnI, 19,20,22 four used hsTnT 15,16,21 and one assayed both. 17 The analyser for hsTnT was produced by Roche Diagnostics in all (99% cut-off 14 ng/L), while hsTnI was measured using the Beckman-Coulter AccuTnI Enhanced (cut-off 40 ng/L) in one study, 17 Siemens TnI-Ultra assay (99% cut-off 40 ng/L) in two, 17,22 and the Abbott-Architect assay (99% cut-off: 28 and 32 ng/ L, respectively) in the remainder.…”

“…17 The analyser for hsTnT was produced by Roche Diagnostics in all (99% cut-off 14 ng/L), while hsTnI was measured using the Beckman-Coulter AccuTnI Enhanced (cut-off 40 ng/L) in one study, 17 Siemens TnI-Ultra assay (99% cut-off 40 ng/L) in two, 17,22 and the Abbott-Architect assay (99% cut-off: 28 and 32 ng/ L, respectively) in the remainder. 19,20 Four studies analysed their HT FABP with Randox immunoturbidimetric assay, [16][17][18]22 one by enzyme-linked immunosorbent assay (ELISA) provided by Dainippon Pharmaceutical, Osaka, Japan, 20 one with QuickSenshFABP assay, 21 one by Hycult Biotech, 15 and the last with Innotrac Aiol Immunoanalyser. 19 The prespecified 99% cut-off for HT FABP varied widely between studies (Table 2).…”

“…Consequently, eight studies (Table 1) were included for quantitative analysis. [15][16][17][18][19][20][21][22] Overall, 3395 patients were included in the final analysis. Among these, 716 patients (21.1%) were eventually diagnosed with AMI according to the Universal Definition.…”

“…Among these, 716 patients (21.1%) were eventually diagnosed with AMI according to the Universal Definition. Patients with ST elevation MI (STEMI) were included in four studies, 16,19,20,22 while one study exclusively enrolled patients at low cardiovascular risk. 17 The trials were set in the Emergency Department in seven studies [15][16][17][19][20][21][22] and the coronary care unit in one.…”

“…Patients with ST elevation MI (STEMI) were included in four studies, 16,19,20,22 while one study exclusively enrolled patients at low cardiovascular risk. 17 The trials were set in the Emergency Department in seven studies [15][16][17][19][20][21][22] and the coronary care unit in one. 18 Four studies had a prospective design, 15,[20][21][22] while the rest performed retrospective analyses of frozen plasma samples.…”