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Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction: a systematic review and meta-analysis
  1. Madeleine H E Bruins Slot1,
  2. J B Reitsma2,
  3. Frans H Rutten1,
  4. Arno W Hoes1,
  5. Geert J M G van der Heijden1
  1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, GA Utrecht, The Netherlands
  2. 2Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Madeleine H E Bruins Slot, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands; m.h.e.bruinsslot{at}umcutrecht.nl

Abstract

Objective To determine the accuracy of heart-type fatty acid-binding protein (H-FABP) as a new and early cardiac biomarker in the early diagnosis of acute myocardial infarction (AMI). The introduction of early and safe biomarkers could lead to (a) a large reduction in unnecessary hospital referrals of patients suspected of, but not, having AMI and (b) an earlier start of treatment in patients with AMI.

Design Diagnostic meta-analysis.

Setting Hospital and pre-hospital.

Patients Consecutive patients suspected of having AMI.

Main outcome measures A summary estimate for sensitivity and specificity was calculated using the bivariate random-effects approach, and covariate analysis was used to examine sources of heterogeneity between studies.

Results A systematic search yielded 16 studies (3709 patients, prevalence of AMI 13–74%, male gender 49–84%, median age 64–76 years). The summary estimate was 84% (95% CI 76% to 90%) for sensitivity and 84% (95% CI 76% to 89%) for specificity. Covariate analyses revealed that the use of troponin in the reference standard for AMI (as opposed to creatine kinase or creatine kinase-myocardial band) had a significant impact on sensitivity.

Conclusion H-FABP does not fulfil the requirements needed for a safe and early diagnosis of AMI when used as a stand-alone test. Sound diagnostic studies examining the additional role of H-FABP combined with clinical findings and other diagnostic tests are needed to further clarify a potential future role for this cardiac biomarker.

  • Acute coronary syndrome
  • biomarker
  • heart-type fatty acid-binding protein
  • diagnosis
  • meta-analysis
  • emergency medicine
  • acute coronary syndrome

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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