title: Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T.
abstract: 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.
authors.affiliation: The Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK.
authors.forename: Conor J
authors.initials: CJ
authors.lastname: McCann
authors.forename: Ben M
authors.initials: BM
authors.lastname: Glover
authors.forename: Ian B A
authors.initials: IB
authors.lastname: Menown
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Moore
authors.forename: Jane
authors.initials: J
authors.lastname: McEneny
authors.forename: Colum G
authors.initials: CG
authors.lastname: Owens
authors.forename: Bernie
authors.initials: B
authors.lastname: Smith
authors.forename: Peter C
authors.initials: PC
authors.lastname: Sharpe
authors.forename: Ian S
authors.initials: IS
authors.lastname: Young
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Adgey
mesh_terms: 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*
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T; D020097:Natriuretic Peptide, Brain