title: Incremental value of heart-type fatty acid-binding protein in suspected acute myocardial infarction early after symptom onset.
abstract: BACKGROUND
  The early diagnosis of acute myocardial infarction (AMI) very soon after symptom onset remains a major clinical challenge, even when using high-sensitivity cardiac troponin (hs-cTnT).
  
  
  RESULTS
  We investigated the incremental value of heart-type fatty acid-binding protein (hFABP) in a pre-specified subgroup analysis of patients presenting with suspected AMI within 1 h of symptom onset to the emergency department (ED) in a multicentre study. HFABP was measured in a blinded fashion. Two independent cardiologists using all available clinical information, including hs-cTnT, adjudicated the final diagnosis. Overall, 1411 patients were enrolled, of whom 105 patients presented within 1 h of symptom onset. Of these, 34 patients (32.4%) had AMI. The diagnostic accuracy as quantified by the area under the receiver-operating characteristics curve (AUC) of hFABP was high (0.84 (95% CI 0.74-0.94)). However, the additional use of hFABP only marginally increased the diagnostic accuracy of hs-cTnT (AUC 0.88 (95% CI 0.81-0.94) for hs-cTnT alone to 0.90 (95% CI 0.83-0.98) for the combination; p=ns). After the exclusion of 18 AMI patients with ST-segment elevation, similar results were obtained. Among the 16 AMI patients without ST-segment elevation, six had normal hs-cTnT at presentation. Of these, hFABP was elevated in two (33.3%) patients.
  
  
  CONCLUSIONS
  hFABP does not seem to significantly improve the early diagnostic accuracy of hs-cTnT in the important subgroup of patients with suspected AMI presenting to the ED very early after symptom onset.
authors: Division of Geriatrics, Department of General Internal Medicine, Inselspital, Bern University Hospital, and University of Bern, Switzerland.
authors: Andreas W
authors: AW
authors: Schoenenberger
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland Department of Internal Medicine, University Hospital Basel, Switzerland.
authors: Fabio
authors: F
authors: Stallone
authors: Central Laboratory, Luzerner Kantonsspital, Switzerland.
authors: Brigitte
authors: B
authors: Walz
authors: Department of Cardiology, Luzerner Kantonsspital, Switzerland.
authors: Michael
authors: M
authors: Bergner
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
authors: Raphael
authors: R
authors: Twerenbold
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
authors: Tobias
authors: T
authors: Reichlin
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
authors: Bernhard
authors: B
authors: Zogg
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
authors: Cedric
authors: C
authors: Jaeger
authors: Department of Cardiology, Luzerner Kantonsspital, Switzerland Cardiovasc Schweiz AG, Hirslanden Klinik St Anna, Switzerland paul.erne@erne-net.ch.
authors: Paul
authors: P
authors: Erne
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Switzerland.
authors: Christian
authors: C
authors: Mueller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000378:metabolism*; D011446:Prospective Studies; D012372:ROC Curve; D020107:Troponin T / Q000378:metabolism; D055815:Young Adult
chemical_list: C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T
keywords: Human heart-type fatty acid-binding protein; acute myocardial infarction; early diagnosis; troponin t