title: Heart-type fatty acid binding protein and the diagnosis of acute coronary syndrome in the ED.
abstract: BACKGROUND
  In combination with cardiac troponin, heart-type fatty acid binding protein (h-FABP)-a biomarker of myocardial necrosis-offers the possibility of rapidly eliminating the diagnosis of acute myocardial infarction (AMI).
  
  
  OBJECTIVE
  The main objective of this study was to assess the incremental value of h-FABP to cardiac troponin for a rapid elimination of AMI, according to the pretest probability (PTP) of AMI.
  
  
  METHODS
  In consecutive patients presenting to emergency departments (ED) with chest pain less than 6 hours suggestive of AMI, h-FABP levels were measured, blinded to the ED physicians, who were asked to quote the PTP of AMI. The discharge diagnosis was adjudicated by 2 independent experts, blind to the h-FABP level.
  
  
  RESULTS
  Three hundred seventeen patients (mean age of 57 years) were included in whom 149 had (47%) low, 117 (37%) moderate, and 51 (16%) high PTP. The final diagnosis was AMI in 45 patients (14%), including 16 STEMIs (5%). The negative predictive value for diagnostic elimination of AMI of an h-FABP less than 3 μg/L, combined with a negative cTnI was not higher than that of cardiac troponin I (cTnI) alone (96% [95% confidence interval, 93%-98%] vs 95% [93%-98%]), regardless of the PTP). Even in the low-PTP group, we did not demonstrate a significant improvement in negative predictive value with the addition of h-FABP, compare with that of cTnI alone (100% [97%-100%] vs 99% [96%-100%]).
  
  
  CONCLUSIONS
  In triage of patients with chest pain, use of h-FABP does not provide useful additional information to cTnI for excluding the diagnosis of ST-elevation myocardial infarction and non-ST-elevation myocardial infarction diagnosis, whatever the PTP.
authors.affiliation: Department of Emergency Department, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, Univ UPMC Paris 6, 75005 Paris, France. yonathanfreund@gmail.com
authors.forename: Yonathan
authors.initials: Y
authors.lastname: Freund
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.forename: François
authors.initials: F
authors.lastname: Leumani
authors.forename: Yann-Erick
authors.initials: YE
authors.lastname: Claessens
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Allo
authors.forename: Benoit
authors.initials: B
authors.lastname: Doumenc
authors.forename: Claudine
authors.initials: C
authors.lastname: Cosson
authors.forename: Pascale
authors.initials: P
authors.lastname: Bonnet
authors.forename: Bruno
authors.initials: B
authors.lastname: Riou
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D000368:Aged; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis; D004636:Emergency Service, Hospital; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D019210:Troponin I / Q000097:blood
chemical_list: C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D019210:Troponin I