title: Performances of the heart fatty acid protein assay for the rapid diagnosis of acute myocardial infarction in ED patients.
abstract: OBJECTIVE
  We sought to evaluate the added value of heart fatty acid protein assay (HFABP) for rapid diagnosis of acute myocardial infarction in a prospective cohort of emergency department (ED) patients with acute chest pain.
  
  
  METHODS
  High-sensitivity cardiac troponin T (hs-cTnT; Roche Diagnostics, Meylan, France) and HFABP (Randox, Mauguio, France) were blindly assayed from venous blood samples obtained at admission. Diagnosis was made by 2 ED physicians using all available data and serial cardiac troponin I as the biochemical standard. Diagnostic performances of HFABP combined with hs-cTnT were assessed using logistic regression. Analysis was conducted in all patients and in patients without ST-elevation myocardial infarction.
  
  
  RESULTS
  A total of 181 patients were included (age, 61 ±17 years; male sex, 66%). Acute myocardial infarction occurred in 47 (25.9%) patients, including non-ST-elevation myocardial infarction in 31 (17.1%). The receiver operating characteristic area under the curve was 0.893 for hs-cTnT levels at presentation (95% confidence interval, 0.812-0.974) and 0.908 (95% confidence interval, 0.839-0.977) for the combination of hs-cTnT and HFABP, with no significant (P=.07). Adding HFABP to hs-cTnT increased both sensitivity and negative predictive value (NPV) for non-ST-elevation myocardial infarction diagnosis, with about 13% and 3% increase, respectively, leading to a sensitivity of 97% and an NPV of 99%.
  
  
  CONCLUSIONS
  The assessment of HFABP at ED admission adds incremental value to initial hs-cTnT. The increase of sensitivity and NPV without sacrificing the specificity and positive predictive value in patients with chest pain with noncontributive electrocardiogram could potentially allow safe and early rule out of acute myocardial infarction without the need for further serial troponin testing.
authors.affiliation: Biochemistry Laboratory, Lapeyronie Hospital, Montpellier, France. Electronic address: am-dupuy@chu-montpellier.fr.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Dupuy
authors.affiliation: Biochemistry Laboratory, Lapeyronie Hospital, Montpellier, France.
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Cristol
authors.affiliation: Biochemistry Laboratory, Lapeyronie Hospital, Montpellier, France.
authors.forename: Nils
authors.initials: N
authors.lastname: Kuster
authors.affiliation: Biochemistry Laboratory, Lapeyronie Hospital, Montpellier, France.
authors.forename: Robin
authors.initials: R
authors.lastname: Reynier
authors.affiliation: Emergency Department, Lapeyronie Hospital, Montpellier, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lefebvre
authors.affiliation: Biochemistry Laboratory, Lapeyronie Hospital, Montpellier, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Badiou
authors.affiliation: Emergency Department, Lapeyronie Hospital, Montpellier, France.
authors.forename: Riad
authors.initials: R
authors.lastname: Jreige
authors.affiliation: Emergency Department, Lapeyronie Hospital, Montpellier, France.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Sebbane
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
chemical_list: D050556:Fatty Acid-Binding Proteins; D020107:Troponin T