title: Heart-type fatty acid binding protein as an adjunct to cardiac troponin-I for the diagnosis of myocardial infarction.
abstract: We hypothesized that when used in combination with cardiac troponins, heart-type fatty acid binding protein (H-FABP) would have greater diagnostic value than conventional markers for the early diagnosis of myocardial infarction (MI). Patients with typical chest pain at a single emergency department were consecutively enrolled. Initial blood samples were drawn for H-FABP, myoglobin, creatine kinase isoenzyme MB (CK-MB), and cardiac troponin-I (cTnI) measurements. MI was defined by serial cTnI measurements. To evaluate the adjunctive role of biochemical markers, we derived and compared logistic regression models predicting MI in terms of their discrimination (area under the receiver operating characteristics curve, AUC) and overall fit (Bayesian information criterion, BIC). Seventy-six of 170 patients were diagnosed as having MI. The AUC of cTnI, H-FABP, myoglobin, and CK-MB were 0.863, 0.827, 0.784, and 0.772, respectively. A logistic regression model using cTnI (P = 0.001) and H-FABP (P < 0.001) had the biggest AUC (0.900) and the best fit determined by BIC. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of this model at 30% probability were 81.6%, 80.9%, 4.26, and 0.23, respectively. H-FABP has a better diagnostic value than both myoglobin and CK-MB as an adjunct to cTnI for the early diagnosis of MI.
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Kyung Su
authors.initials: KS
authors.lastname: Kim
authors.forename: Hui Jai
authors.initials: HJ
authors.lastname: Lee
authors.forename: Kyuseok
authors.initials: K
authors.lastname: Kim
authors.forename: You Hwan
authors.initials: YH
authors.lastname: Jo
authors.forename: Tae Yun
authors.initials: TY
authors.lastname: Kim
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Joong Eui
authors.initials: JE
authors.lastname: Rhee
authors.forename: Gil Joon
authors.initials: GJ
authors.lastname: Suh
authors.forename: Mi Ran
authors.initials: MR
authors.lastname: Kim
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Lee
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000150:complications; D052279:Creatine Kinase, MB Form / Q000097:blood; D042241:Early Diagnosis; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D019210:Troponin I / Q000097:blood*
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D009211:Myoglobin; D019210:Troponin I; D052279:Creatine Kinase, MB Form