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32 Highly selective troponin T (hsTnT) and heart-type fatty acid-binding protein (H-FABP) as markers of type 4A myocardial infarction and adverse events in elective percutaneous coronary intervention (PCI)
  1. M Connolly1,
  2. J Shand1,
  3. M Kinnin1,
  4. MJ Kurth2,
  5. J Lamont2,
  6. I Menown1,
  7. D McEneaney1
  1. 1Cardiovascular Research Unit, Craigavon Cardiac Centre, Southern Trust, UK
  2. 2Randox Laboratories Ltd, Crumlin, UK

Abstract

Introduction Heart-type Fatty Acid-Binding Protein (H-FABP) may be useful for early diagnosis of ACS1,2 and has been associated with increased cardiovascular events. Type 4 a procedural myocardial infarction (MI) may occur after percutaneous coronary intervention (PCI).3 Little is known about the use of early biomarkers as predictors of cardiovascular events following elective PCI.

Methods We prospectively evaluated highly sensitive troponin T (hsTnT), H-FABP, troponin I (TnI), creatine kinase MB type (CKMB), myoglobin, glycogen phosphorylase BB (GPBB) and carbonic anhydrase 3 (CA3) at 0, 4, 6 and 24 hours following elective PCI. Baseline demographic and cardiac risk factors were recorded. The primary endpoint was type 4 a MI, diagnosed as a rise of >5 × 99th upper reference limit (URL) of 14 ng/dl (i.e., rise of >70 ng/dl) at 6 hours if hsTnT was normal at baseline or >20% from 0 to 6 hours if hsTnT was >14 ng/dl at baseline.3 Patients were followed up at 1 year to assess for major adverse clinical events (MACE); MI, target vessel revascularisation, heart failure, stroke and death.

Results We enrolled 241 patients of whom 32 were excluded due to withdrawal of consent or PCI being cancelled after angiography. A cohort of 209 patients was included in analysis, of whom 144 (68.9%) were male, mean age was 68.8 years, 28 (13.4%) were smokers, 31 (14.8%) were diabetic, 199 (95.2%) had hypercholesterolaemia and 138 (66.0%) had hypertension. Type 4 a MI was observed in 37 (17.7%) patients. Comparing those with and without type 4 a MI, there was no statistical difference in risk factors (p > 0.05) except for age (p = 0.015). Median troponin at 6 hours was 90.24 ng/dl (95% CI: 76.56–186.41) versus 14.43 ng/dl (95% CI: 16.37–21.26) in the type 4 a/non type 4 a groups respectively, p ≤ 0.001, Figure 1. Median H-FABP at 4 hours was most predictive of type 4 a MI (followed by CKMB and myoglobin) with levels of 6.23 ng/l (95% CI: 4.38–18.96), versus 2.05 ng/l (95% CI: 2.23–2.74), p ≤ 0.001, AUC 0.91, Table 1, Figure 2. Results for TnI, CKMB, myoglobin, GBPP and CA3 are shown in Table 1. Multivariate logistic regression (stepwise elimination) showed H-FABP to be most predictive of type 4 a MI, p < 0.001. Sensitivity of 4 hour H-FABP (>6.32 ng/ml) for type 4 a MI was 51.5%, specificity 96.1%, positive predictive value (PPV) 73.9%, negative predictive value (NPV) 90.3%, odds ratio (OR) 26.39, relative risk (RR) 7.62. MACE was noted in 6 (2.9%) patients (three MI, two death and one stroke), 3 of which had type 4 a MI at index PCI, p = 0.036. Table 2 compares median change in H-FABP and hsTnT from 0–6 hours in patients who developed MACE at 1 year with CA3 performing best, p = 0.02.

Abstract 32 Figure 1

hsTnT release between type 4a (n = 37) and no type 4a MI (n = 172)

Abstract 32 Table 1

Summary of biomarker results at 4 hours

Abstract 32 Figure 2

H-FABP release between type 4a (n = 37) and no type 4a MI (n = 172)

Abstact 32 Table 2

Summary of biomarker change from 0–6 hours in 1 year MACE and non MACE patients

Conclusions/implications Median 4 hour H-FABP was most predictive of a 6 hour hsTnT rise as a consequence of type 4 a MI in elective PCI, followed by CKMB and myoglobin. H-FABP, hsTnT and CA3 were predictive of MACE at 1 year.

References

  1. McCann CJ, Glover BM, Menown IB, Moore MJ, McEneny J, Owens CG, Smith B, Sharpe PC, Young IS, Adgey JA. Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T. Eur Heart J 2008;29(23):2843–50

  2. Body R, Carley S, Burrows G, Pemberton P, Mackway-Jones K. Combining heart fatty acid binding protein and high sensitivity troponin in the emergency department. 14th International Conference on Emergency Medicine. Acad Emerg Med 2012;19(6):748–9

  3. Thygesen K, Alpert J, Jaffe A, Simoons M, Chaitman R, White H. Third universal definition of myocardial infarction. ESC/ACCF/AHA/WHF expert consensus document. J Am Coll Cardiol 2012;60(16):1581–98

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