title: Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To determine the accuracy of heart-type fatty acid-binding protein (H-FABP) as a new and early cardiac biomarker in the early diagnosis of acute myocardial infarction (AMI). The introduction of early and safe biomarkers could lead to (a) a large reduction in unnecessary hospital referrals of patients suspected of, but not, having AMI and (b) an earlier start of treatment in patients with AMI.
  
  
  METHODS
  Diagnostic meta-analysis.
  
  
  METHODS
  Hospital and pre-hospital.
  
  
  METHODS
  Consecutive patients suspected of having AMI.
  
  
  METHODS
  A summary estimate for sensitivity and specificity was calculated using the bivariate random-effects approach, and covariate analysis was used to examine sources of heterogeneity between studies.
  
  
  RESULTS
  A systematic search yielded 16 studies (3709 patients, prevalence of AMI 13-74%, male gender 49-84%, median age 64-76 years). The summary estimate was 84% (95% CI 76% to 90%) for sensitivity and 84% (95% CI 76% to 89%) for specificity. Covariate analyses revealed that the use of troponin in the reference standard for AMI (as opposed to creatine kinase or creatine kinase-myocardial band) had a significant impact on sensitivity.
  
  
  CONCLUSIONS
  H-FABP does not fulfil the requirements needed for a safe and early diagnosis of AMI when used as a stand-alone test. Sound diagnostic studies examining the additional role of H-FABP combined with clinical findings and other diagnostic tests are needed to further clarify a potential future role for this cardiac biomarker.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA Utrecht, The Netherlands. m.h.e.bruinsslot@umcutrecht.nl
authors.forename: Madeleine H E
authors.initials: MH
authors.lastname: Bruins Slot
authors.forename: J B
authors.initials: JB
authors.lastname: Reitsma
authors.forename: Frans H
authors.initials: FH
authors.lastname: Rutten
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D012372:ROC Curve; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins