Acta Pharmacologica Sinica (2010) 31: 307–312; doi: 10.1038/aps.2010.2; published online 5 February 2010

¹Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; ²Department of Cardiology, The Affiliated Hospital of Guiyang Medical College, Guiyang 550004, China; ³Population Health Research Institute, MacMaster University, 237 Barton Street East, Hamilton, ON L8L 2X2, Canada

Aim: To investigate the efficacies of point-of-care test of heart-type fatty-acid binding protein (H-FABP) and its combinations with the conventional biomarkers in the diagnosis of early acute myocardial infarction (AMI).

Methods: 227 patients suspected of AMI were consecutively recruited in two centers.  Biomarkers including H-FABP, myoglobin (MYO), creatine kinase-myocardial band (CK-MB) and cardiac troponin T (cTnT) were determined simultaneously at admission.  AMI was defined according to the universal definition of myocardial infarction.  Chi-Square test was adopted for the analysis. 

Results: In patients presenting within 12 h of symptom onset, the sensitivity of H-FABP[93.0% (95% CI: 86.6%−96.9%)] was significantly higher than that of initial CK-MB [67.5% (95% CI: 58.1%−76.0%), P<0.0001], cTnT [69.3% (95%CI: 60.0%−77.6%), P<0.0001] and MYO [68.6% (95% CI: 54.1%−80.9%), P<0.05].  The negative predictive value of H-FABP [92.8% (95%CI: 86.3%−96.8%)] was significantly higher than that of initial CK-MB [74.7% (95% CI: 66.8%−81.5%), P<0.001] and cTnT [75.9% (95% CI: 68.1%−82.6%), P<0.001].  The sensitivity of H-FABP+cTnT combination [94.7% (95% CI: 88.9%−98.0%)] was significantly higher than that of admission cTnT [69.3% (95% CI: 60.0%−77.6%), P<0.0001], CK-MB+cTnT [75.4% (95% CI: 66.5%−83.0%), P<0.0001] and MYO+CK-MB+cTnT [74.5% (95% CI: 60.4%−85.7%), P<0.05].  The negative predictive value of H-FABP+cTnT [94.5% (95% CI: 88.4%−98.0%] was significantly higher than that of initial cTnT [75.9% (95% CI: 68.1%−82.6%), P<0.001] and CK-MB+cTnT [79.1% (95% CI: 71.2%−85.6%), P<0.001].  Subgroup analysis showed that the superiorities of both the sensitivities and the negative predictive values of H-FABP and H-FABP+cTnT combination occurred only in patients who presented within 6 h of the symptom onset.

Conclusion: Point-of-care test of H-FABP can be used as a valuable biomarker to detect or exclude an early-stage AMI.  Combining H-FABP and cTnT provides the best performance for early AMI diagnosis.

Keywords: point-of-care test; heart-type fatty-acid binding protein; acute myocardial infarction; diagnosis