title: Diagnostic accuracy of quantitative heart-fatty acid binding protein assays compared with Cardiodetect(®) in the early detection of acute coronary syndrome.
abstract: BACKGROUND
  Heart-fatty acid binding protein (h-FABP) has been proposed as a cardiac marker for the early detection of acute coronary syndrome (ACS). In a study of 677 patients admitted to the emergency department (ED) for chest pain, we found that a semiquantitative point-of-care test that detects h-FABP (Cardiodetect(®)) had low sensitivity for the prediction of ACS.
  
  
  OBJECTIVE
  The aim of this ancillary study was to analyze and compare the performance of h-FABP for early ACS diagnosis in this large cohort of unselected patients, using a quantitative immunoassay and Cardiodetect(®).
  
  
  METHODS
  h-FABP was measured with a ready-to-use, solid-phase, enzyme-linked immunosorbent assay (ELISA) in 677 patients admitted to the ED with chest pain and suspected non-ST-segment elevation ACS. Two physicians, blinded to the results of the marker, categorized patients as having or not having non-ST-segment elevation ACS.
  
  
  RESULTS
  Non-ST-segment elevation ACS was diagnosed in 185 patients (27.3%). The median h-FABP level was higher in patients with ACS (1.36μg/L, interquartile range [IQR] 0.59-3.55) than in those without ACS (0.58μg/L, IQR 0.24-1.34; P<0.01). The area under the curve was 0.68 (95% confidence interval [CI] 0.63-0.73). h-FABP did not improve the performance of a model that included the usual diagnostic tools for ACS management (odds ratio 0.92, 95% CI 0.32-2.70). The classification agreement between the ELISA and Cardiodetect(®) was 92.1% (kappa 0.39).
  
  
  CONCLUSIONS
  In this study, we confirmed that measurement of h-FABP was insufficient to be used as a marker of ACS and NSTEMI in ED, whatever the analytical technique used.
authors: Emergency Department, Purpan University Hospital, Toulouse cedex, France. charpentier.s@chu-toulouse.fr
authors: Sandrine
authors: S
authors: Charpentier
authors: Françoise
authors: F
authors: Maupas-Schwalm
authors: Maxime
authors: M
authors: Cournot
authors: Meyer
authors: M
authors: Elbaz
authors: Jean-Louis
authors: JL
authors: Ducassé
authors: Jean-Marie
authors: JM
authors: Bottela
authors: Dominique
authors: D
authors: Lauque
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D004797:Enzyme-Linked Immunosorbent Assay; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D005602:France; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins