Early markers of myocardial injury: cTnI is enough.
BACKGROUND
We compared the early diagnostic and prognostic performance of a highly sensitive cardiac troponin I (cTnI) assay with heart-type fatty acid binding protein (H-FABP), in the early hours of acute coronary syndrome.


METHODS
Serum samples of 293 patients were studied using the Abbott Architect cTnI assay and the H-FABP assay. Special attention was paid to the diagnostic and prognostic value of admission blood samples taken <24 h after symptom onset. The prognostic endpoint was total mortality and reinfarction at 6 months.


RESULTS
To detect forthcoming myocardial injury, admission samples gave receiver operating curve (ROC) areas (AUC) of 0.908 for cTnI and 0.855 for H-FABP (p=0.068) when the delay from symptom onset was <6 h (60.4% of all patients). When the delay was 6-24 h, the corresponding AUC values were 0.995 for cTnI and 0.849 for H-FABP (p=0.002). In multivariate analysis cTnI but not H-FABP predicted adverse events in all 293 patients (RR 3.02, 95% CI 1.62-5.63) and in those with delays <6 h (RR 2.92, 95% CI 1.47-5.81).


CONCLUSIONS
In the era of highly sensitive cTnI assays, H-FABP appears to give no additional information even in patients who present within the first 6 h after acute MI.
Ilva
Tuomo
T
Department of Medicine, University of Turku, FIN-20520 Turku, Finland. tuomo.ilva@pp.inet.fi
Lund
Juha
J
Porela
Pekka
P
Mustonen
Harri
H
Voipio-Pulkki
Liisa-Maria
LM
Eriksson
Susann
S
Pettersson
Kim
K
Tanner
Pirjo
P
Pulkki
Kari
K
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009206:Myocardium / Q000378:metabolism*; D010343:Patient Admission; D011379:Prognosis; D012680:Sensitivity and Specificity; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D019210:Troponin I