Original Article

Point-of-care test of heart-type fatty acid-binding protein for the diagnosis of early acute myocardial infarction

Authors: Chun-jian Li, Jie-qi Li, Xiao-fang Liang, Xiao-xiang Li, Jian-guo Cui, Zhi-jian Yang, Qing Guo, Ke-jiang Cao, Jun Huang
DOI: 10.1038/aps.2010.2

Abstract

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.
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