Heart-type fatty acid binding protein and the diagnosis of acute coronary syndrome in the ED

• Published in: The American journal of emergency medicine 2012-10, Vol.30 (8), p.1378-1384
• Main Authors: Freund, Yonathan, MD, Chenevier-Gobeaux, Camille, MD, Leumani, François, MD, Claessens, Yann-Erick, MD, PhD, Allo, Jean-Christophe, MD, Doumenc, Benoit, MD, Cosson, Claudine, MD, Bonnet, Pascale, MD, Riou, Bruno, MD, PhD, Ray, Patrick, MD, PhD
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute coronary syndromes; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angina pectoris; Biological and medical sciences; Cardiology. Vascular system; Chest Pain - blood; Chest Pain - diagnosis; Coronary heart disease; Emergency; Emergency medical care; Emergency Service, Hospital; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins - blood; Fatty acids; Female; Glomerular Filtration Rate; Heart; Heart attacks; Hospitals; Humans; Intensive care medicine; Male; Medical sciences; Middle Aged; Myocardial infarction; Myocardial Infarction - blood; Myocardial Infarction - diagnosis; Pain; Troponin I - blood
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2011.10.001

Abstract Background In combination with cardiac troponin, heart-type fatty acid binding protein (h-FABP)—a biomarker of myocardial necrosis—offers the possibility of rapidly eliminating the diagnosis of acute myocardial infarction (AMI). Objective The main objective of this study was to assess the incremental value of h-FABP to cardiac troponin for a rapid elimination of AMI, according to the pretest probability (PTP) of AMI. Methods In consecutive patients presenting to emergency departments (ED) with chest pain less than 6 hours suggestive of AMI, h-FABP levels were measured, blinded to the ED physicians, who were asked to quote the PTP of AMI. The discharge diagnosis was adjudicated by 2 independent experts, blind to the h-FABP level. Results Three hundred seventeen patients (mean age of 57 years) were included in whom 149 had (47%) low, 117 (37%) moderate, and 51 (16%) high PTP. The final diagnosis was AMI in 45 patients (14%), including 16 STEMIs (5%). The negative predictive value for diagnostic elimination of AMI of an h-FABP less than 3 μ g/L, combined with a negative cTnI was not higher than that of cardiac troponin I (cTnI) alone (96% [95% confidence interval, 93%-98%] vs 95% [93%-98%]), regardless of the PTP). Even in the low-PTP group, we did not demonstrate a significant improvement in negative predictive value with the addition of h-FABP, compare with that of cTnI alone (100% [97%-100%] vs 99% [96%-100%]). Conclusion In triage of patients with chest pain, use of h-FABP does not provide useful additional information to cTnI for excluding the diagnosis of ST-elevation myocardial infarction and non–ST-elevation myocardial infarction diagnosis, whatever the PTP.