Prognostic utility of heart-type fatty acid binding protein in patients with acute coronary syndromes.
BACKGROUND
Heart-type fatty acid binding protein (H-FABP) is a cytosolic protein that is released rapidly from the cardiomyocyte in response to myocardial injury. Although it has been investigated as an early marker of acute myocardial infarction, its prognostic utility in acute coronary syndromes has not been established.


RESULTS
We measured H-FABP in 2287 patients with acute coronary syndromes from the OPUS-TIMI 16 trial. H-FABP was elevated (> 8 ng/mL) in 332 patients (14.5%). Patients with an elevated H-FABP were more likely to suffer death (hazard ratio [HR], 4.1; 95% CI, 2.6 to 6.5), recurrent myocardial infarction (HR, 1.6; 95% CI, 1.0 to 2.5), congestive heart failure (HR, 4.5; 95% CI, 2.6 to 7.8), or the composite of these end points (HR, 2.6; 95% CI, 1.9 to 3.5) through the 10-month follow-up period. H-FABP predicted the risk of the composite end point both in patients who were troponin I negative (HR, 2.1; 95% CI, 1.3 to 3.4) and in those who were troponin I positive (HR, 3.3; 95% CI, 2.0 to 5.3). In a Cox proportional-hazards model that adjusted for baseline variables, including demographics, clinical characteristics, creatinine clearance, ST deviation, index diagnosis, and troponin I, elevated H-FABP remained a significant predictor of the composite end point (HR, 1.9; 95% CI, 1.3 to 2.7), as well as the individual end points of death (HR, 2.7; 95% CI, 1.5 to 4.9) and CHF (HR, 2.4; 95% CI, 1.2 to 5.0). In a multimarker approach, H-FABP, troponin I, and B-type natriuretic peptide provided complementary information.


CONCLUSIONS
Elevation of H-FABP is associated with an increased risk of death and major cardiac events in patients presenting across the spectrum of acute coronary syndromes and is independent of other established clinical risk predictors and biomarkers.
O'Donoghue
Michelle
M
Cardiovascular Division, Brigham and Women's Hospital, 350 Longwood Ave, First Floor, Boston, Mass 02115, USA.
de Lemos
James A
JA
Morrow
David A
DA
Murphy
Sabina A
SA
Buros
Jacqueline L
JL
Cannon
Christopher P
CP
Sabatine
Marc S
MS
D000208:Acute Disease; D000328:Adult; D000409:Alanine / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011759:Pyrrolidines / Q000008:administration & dosage; D012307:Risk Factors; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D011759:Pyrrolidines; D019210:Troponin I; D020097:Natriuretic Peptide, Brain; C120234:orbofiban; D000409:Alanine