Clinical assessment of ischemia-modified albumin and heart fatty acid-binding protein in the early diagnosis of non-ST-elevation acute coronary syndrome in the emergency department.
OBJECTIVE
Heart fatty acid-binding protein (h-FABP) and ischemia-modified albumin (IMA) have recently been evaluated, but to the best of our knowledge, no study has reported an analysis of these two markers for the detection of early myocardial infarction and myocardial ischemia in a large cohort of consecutive patients presenting to an emergency department (ED). This study evaluates the diagnostic accuracy and the clinical utility of h-FABP and IMA for non-ST-segment elevation acute coronary syndrome (ACS) diagnosis in the first hour of management in an ED.


METHODS
In a prospective 11-month study, 677 patients admitted to the ED with chest pain and suspected non-ST-segment elevation ACS were enrolled. On presentation, blood samples were obtained for the measurement of the biomarkers h-FABP (immunodetection with CardioDetect) and IMA (albumin cobalt-binding test). Two physicians, blinded to the results of the markers, independently categorized patients as having or not having non-ST-segment elevation ACS.


RESULTS
Of the 677 patients who were prospectively recruited, non-ST-segment elevation ACS was diagnosed in 185 (27.3%). While IMA was not predictive of the ACS diagnosis (odds ratio [OR] = 1.23; 95% CI = 0.87 to 1.81), h-FABP was predictive of ACS diagnosis (OR = 4.65; 95% CI = 2.39 to 9.04) with specificity at 96.8% (95% CI = 95.4% to 98.1%) and sensitivity at 13.5% (95% CI = 10.9% to 16.1%). However, h-FABP did not add significant additional information to a predictive model that included the usual diagnostic tools for non-ST-elevation ACS management (p = 0.40).


CONCLUSIONS
In this study on a large cohort of patients admitted to an ED for chest pain, IMA and h-FABP did not provide valuable information for ACS diagnosis.
Charpentier
Sandrine
S
Emergency Department, Purpan University Hospital, Toulouse, France. charpentier.s@chu-toulouse.fr
Ducassé
Jean Louis
JL
Cournot
Maxime
M
Maupas-Schwalm
Françoise
F
Elbaz
Meyer
M
Baixas
Cécile
C
Juchet
Henri
H
Lang
Thierry
T
Lauque
Dominique
D
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000032:analysis*; D015415:Biomarkers / Q000097:blood; D004636:Emergency Service, Hospital; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D005602:France; D006801:Humans; D007511:Ischemia; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity
D000418:Albumins; D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins