title: Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction.
abstract: OBJECTIVE
  To investigate the diagnostic and prognostic role of heart-type fatty acid-binding protein (hFABP) compared with copeptin and in addition to high-sensitivity cardiac troponin T (hs-cTnT) in patients with chest pain suspected of acute myocardial infarction (AMI).
  
  
  METHODS
  Diagnostic and prognostic performances of hFABP, copeptin and hs-cTnT were evaluated and compared. The final diagnosis was adjudicated by two independent cardiologists.
  
  
  METHODS
  This prospective observational multicentre study took place in four primary and one secondary hospital from April 2006 to September 2009.
  
  
  METHODS
  We enrolled 1247 consecutive patients with suspected AMI to the emergency department. For analysis, patients were included, if baseline levels for hs-cTnT and hFABP were available (n=1074), patients with ST-segment elevation myocardial infarction (STEMI) were excluded for the diagnostic analysis (n=43).
  
  
  METHODS
  Treatment was left to the discretion of the emergency physician.
  
  
  METHODS
  AMI and mortality.
  
  
  RESULTS
  4% of the patients had STEMI and 16% of the patients had non-STEMI. Patients with AMI had significantly higher levels of hFABP at presentation (p<0.001). Neither the combination with hFABP nor with copeptin increased the diagnostic accuracy of hs-cTnT at admission, quantified by the area under the receiver operating characteristic curve (AUC) (p>0.05). The negative predictive value regarding 90-day, 1-year and 2-year mortality was 100% (99-100), 99% (98-100) and 98% (96-99), respectively, for hFABP levels below the median (p<0.001). The accuracy of hFABP to predict 90-day mortality was moderate (AUC 0.83; 95% CI 0.77 to 0.90).
  
  
  CONCLUSIONS
  hFABP and copeptin do not improve the diagnosis of patients with chest pain without ST-segment elevation, but may be useful for risk stratification beyond hs-TnT.
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: Miriam
authors.initials: M
authors.lastname: Reiter
authors.forename: Raphael
authors.initials: R
authors.lastname: Twerenbold
authors.forename: Tobias
authors.initials: T
authors.lastname: Reichlin
authors.forename: Mira
authors.initials: M
authors.lastname: Mueller
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hoeller
authors.forename: Berit
authors.initials: B
authors.lastname: Moehring
authors.forename: Philip
authors.initials: P
authors.lastname: Haaf
authors.forename: Karin
authors.initials: K
authors.lastname: Wildi
authors.forename: Salome
authors.initials: S
authors.lastname: Merk
authors.forename: Denise
authors.initials: D
authors.lastname: Bernhard
authors.forename: Christa Zellweger
authors.initials: CZ
authors.lastname: Mueller
authors.forename: Michael
authors.initials: M
authors.lastname: Freese
authors.forename: Heike
authors.initials: H
authors.lastname: Freidank
authors.forename: Isabel
authors.initials: I
authors.lastname: Campodarve Botet
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D004562:Electrocardiography; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D020107:Troponin T / Q000097:blood
chemical_list: C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T