Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T.
OBJECTIVE
To evaluate the role of novel biomarkers in early detection of acute myocardial infarction (MI) in patients admitted with acute chest pain.


RESULTS
A prospective study of 664 patients presenting to two coronary care units with chest pain was conducted over 3 years from 2003. Patients were assessed on admission: clinical characteristics, ECG (electrocardiogram), renal function, cardiac troponin T (cTnT), heart fatty acid binding protein (H-FABP), glycogen phosphorylase-BB, NT-pro-brain natriuretic peptide, D-dimer, hsCRP (high sensitivity C-reactive protein), myeloperoxidase, matrix metalloproteinase-9, pregnancy associated plasma protein-A, soluble CD40 ligand. A > or = 12 h cTnT sample was also obtained. MI was defined as cTnT > or = 0.03 microg/L. In patients presenting <4 h of symptom onset, sensitivity of H-FABP for MI was significantly higher than admission cTnT (73 vs. 55%; P = 0.043). Specificity of H-FABP was 71%. None of the other biomarkers challenged cTnT. Combined use of H-FABP and cTnT (either one elevated initially) significantly improved the sensitivities of H-FABP or cTnT (85%; P < or = 0.004). This combined approach also improved the negative predictive value, negative likelihood ratio, and the risk ratio.


CONCLUSIONS
Assessment of H-FABP within the first 4 h of symptoms is superior to cTnT for detection of MI, and is a useful additional biomarker for patients with acute chest pain.
McCann
Conor J
CJ
The Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK.
Glover
Ben M
BM
Menown
Ian B A
IB
Moore
Michael J
MJ
McEneny
Jane
J
Owens
Colum G
CG
Smith
Bernie
B
Sharpe
Peter C
PC
Young
Ian S
IS
Adgey
Jennifer A
JA
D000789:Angina, Unstable / Q000175:diagnosis*; D015415:Biomarkers / Q000378:metabolism; D002637:Chest Pain / Q000209:etiology; D004562:Electrocardiography; D004812:Epidemiologic Methods; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D011379:Prognosis; D020107:Troponin T / Q000378:metabolism*
D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T; D020097:Natriuretic Peptide, Brain