title: Point-of-care heart-type fatty acid binding protein versus high-sensitivity troponin T testing in emergency patients at high risk for acute coronary syndrome.
abstract: BACKGROUND
  High-sensitivity cardiac troponin testing is used to detect myocardial damage in patients with acute chest pain. Heart-type fatty acid binding protein (H-FABP) may be an alternative, available as point-of-care test.
  
  
  METHODS
  Patients (n=203) referred by general practitioners for suspected acute coronary syndrome or presenting with typical chest pain and one major cardiovascular risk factor at the emergency department were prospectively included in a single-centre cohort study. High-sensitivity cardiac troponin T (hs-TnT) and point-of-care H-FABP testing were concomitantly performed at admission and after 6h.
  
  
  RESULTS
  Maximal hs-TnT levels above the 99th percentile were observed in 152 patients (75%) with 127 (63%) fulfilling criteria for myocardial infarction. Upon admission, hs-TnT and H-FABP were associated with an area under the curve (95% CI) of 0.83 (0.77-0.89) and 0.79 (0.73-0.85), respectively, to predict myocardial infarction, which increased to 0.93 (0.90-0.97) and 0.88 (0.84-0.93), respectively, after 6h. The diagnostic accuracy for non-ST-segment elevation myocardial infarction was somewhat lower with an area under the curve (95% CI) of 0.80 (0.72-0.87), 0.90 (0.84-0.96), 0.73 (0.64-0.81) and 0.77 (0.67-0.86), respectively. When assessment was performed within 3h of chest pain onset, diagnostic accuracy of H-FABP versus hs-TnT was similar. Each standard deviation increase in admission H-FABP was associated with a 68% relative risk increase of all-cause mortality (p-value=0.027) during 666 ± 155 days of follow-up.
  
  
  CONCLUSIONS
  Point-of-care H-FABP testing has lower diagnostic accuracy compared with hs-TnT assessment in patients with high pre-test acute coronary syndrome probability, but might be of interest when assessment is possible early after chest pain onset.
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors: Sebastiaan
authors: S
authors: Kellens
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium frederik.verbrugge@zol.be.
authors: Frederik H
authors: FH
authors: Verbrugge
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors: Maxime
authors: M
authors: Vanmechelen
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
authors: Lars
authors: L
authors: Grieten
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors: Johan
authors: J
authors: Van Lierde
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
authors: Joseph
authors: J
authors: Dens
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors: Mathias
authors: M
authors: Vrolix
authors: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
authors: Pieter
authors: P
authors: Vandervoort
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000378:metabolism*; D000368:Aged; D019540:Area Under Curve; D015331:Cohort Studies; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000032:analysis / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000032:analysis / Q000378:metabolism*
chemical_list: C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T
keywords: Acute coronary syndrome; FABP3 protein; myocardial infarction; prognosis