title: Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study.
abstract: BACKGROUND
  Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset.
  
  
  RESULTS
  Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test p<0.001) and increased area under the receiver operating characteristics curve (AUC; 0.82 vs. 0.84 and 0.84). This added value attenuated, however, after inclusion of hs-cTnT in the diagnostic model (AUC 0.88).
  
  
  CONCLUSIONS
  In patients suspected of acute coronary syndrome presenting to the emergency department, H-FABP testing improves diagnostic accuracy in addition to clinical findings and electrocardiography. H-FABP, however, has no additional diagnostic value when hs-cTnT measurements are also available.
authors.affiliation: Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands iem.bank@meandermc.nl.
authors.forename: Ingrid Em
authors.initials: IE
authors.lastname: Bank
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands Department of Cardiology, Isala Clinics, Zwolle, The Netherlands.
authors.forename: Marieke S
authors.initials: MS
authors.lastname: Dekker
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
authors.forename: Nicolaas Pa
authors.initials: NP
authors.lastname: Zuithoff
authors.affiliation: Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Peter Whm
authors.initials: PW
authors.lastname: Verheggen
authors.affiliation: Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Evelyn A
authors.initials: EA
authors.lastname: de Vrey
authors.affiliation: Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: Thierry X
authors.initials: TX
authors.lastname: Wildbergh
authors.affiliation: Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Timmers
authors.affiliation: Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands Department of Surgery, NUS & Cardiovascular Research Institute, NUHCS, Singapore.
authors.forename: Dominique Pv
authors.initials: DP
authors.lastname: de Kleijn
authors.affiliation: Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, The Netherlands.
authors.forename: Jan Fc
authors.initials: JF
authors.lastname: Glatz
authors.affiliation: Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands Laboratory of Experimental Cardiology, University Medical Centre Utrecht, The Netherlands Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands.
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000378:metabolism; D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D004797:Enzyme-Linked Immunosorbent Assay; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000378:metabolism*
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T
keywords: Acute coronary syndrome (ACS); biomarker; heart-type fatty acid binding protein (H-FABP); high sensitivity troponin; point-of care test