Prognostic value of serum concentration of heart-type fatty acid-binding protein relative to cardiac troponin T on admission in the early hours of acute coronary syndrome.
BACKGROUND
Heart-type fatty acid-binding protein (H-FABP) is proposed as an early biomarker for acute myocardial infarction (AMI), but its prognostic value is unclear in acute coronary syndrome (ACS). We evaluated the prognostic value of the H-FABP concentration relative to cardiac troponin T (cTnT) in the early hours of ACS.


METHODS
Serum concentrations of H-FABP and cTnT were measured on admission in 328 consecutive patients hospitalized for ACS within 6 h after the onset of chest pain [AMI, 241 (73.5%) patients; ST-segment elevation myocardial infarction, 154 (47.0%) patients; and emergent coronary angiography within 24 h after admission, 287 (87.5%) patients]. Cardiac events, which were defined as cardiac death or subsequent nonfatal AMI, were monitored for 6 months after admission.


RESULTS
During the 6-month follow-up period, there were 25 cardiac events, including 15 cardiac deaths and 10 subsequent nonfatal AMIs. Stepwise multivariate analyses including clinical, electrocardiographic, and biochemical variables revealed that increased H-FABP (above the median of 9.8 microg/L), but not increased cTnT (above the median of 0.02 microg/L), was independently associated with cardiac events in all patients [relative risk (RR) = 8.96; P = 0.0004], the subgroup of patients with ST-segment elevation myocardial infarction (RR = 11.3; P = 0.02), and the subgroup of patients with unstable angina and non-ST-segment elevation myocardial infarction (RR = 8.31; P = 0.007). The area under the ROC curve was higher for H-FABP than for cTnT (0.711 vs 0.578; P = 0.08), suggesting that H-FABP concentrations have a greater predictive capacity for cardiac events than cTnT.


CONCLUSIONS
Serum H-FABP is a potential independent predictor of cardiac events within 6 months of patient admission and may provide prognostic information superior to cTnT in the early hours of ACS.
Ishii
Junnichi
J
Division of Critical Care, Fujita Health University Graduate School of Health Sciences, Toyoake, Japan. jishii@fujita-hu.ac.jp
Ozaki
Yukio
Y
Lu
Jingchao
J
Kitagawa
Fumihiko
F
Kuno
Takahiro
T
Nakano
Tadashi
T
Nakamura
Yuu
Y
Naruse
Hiroyuki
H
Mori
Yoshihisa
Y
Matsui
Shigeru
S
Oshima
Hisaji
H
Nomura
Masanori
M
Ezaki
Kouji
K
Hishida
Hitoshi
H
D000208:Acute Disease; D015415:Biomarkers / Q000097:blood; D002352:Carrier Proteins / Q000097:blood*; D002637:Chest Pain / Q000175:diagnosis; D003643:Death; D050556:Fatty Acid-Binding Proteins; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis* / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D009206:Myocardium / Q000378:metabolism*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D002352:Carrier Proteins; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T