Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction
- Miriam Reiter1,2,
- Raphael Twerenbold1,2,
- Tobias Reichlin2,3,
- Mira Mueller2,
- Rebecca Hoeller1,2,
- Berit Moehring1,2,
- Philip Haaf2,
- Karin Wildi1,2,
- Salome Merk2,
- Denise Bernhard2,
- Christa Zellweger Mueller1,
- Michael Freese2,
- Heike Freidank4,
- Isabel Campodarve Botet5,
- Christian Mueller1,2
- 1Department of Internal Medicine, University Hospital, Basel, Switzerland
- 2Department of Cardiology, University Hospital, Basel, Switzerland
- 3Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- 4Department of Laboratory Medicine, University Hospital, Basel, Switzerland
- 5Servicio de Urgencias, Hospital del Mar—IMIM, Barcelona, Spain
- Correspondence to Prof Christian Mueller, Department of Cardiology, University Hospital Basel, Petersgraben 4, Basel CH-4031, Switzerland;
- Received 9 November 2012
- Revised 25 February 2013
- Accepted 26 February 2013
- Published Online First 20 March 2013
Objective To investigate the diagnostic and prognostic role of heart-type fatty acid-binding protein (hFABP) compared with copeptin and in addition to high-sensitivity cardiac troponin T (hs-cTnT) in patients with chest pain suspected of acute myocardial infarction (AMI).
Design Diagnostic and prognostic performances of hFABP, copeptin and hs-cTnT were evaluated and compared. The final diagnosis was adjudicated by two independent cardiologists.
Setting This prospective observational multicentre study took place in four primary and one secondary hospital from April 2006 to September 2009.
Patients We enrolled 1247 consecutive patients with suspected AMI to the emergency department. For analysis, patients were included, if baseline levels for hs-cTnT and hFABP were available (n=1074), patients with ST-segment elevation myocardial infarction (STEMI) were excluded for the diagnostic analysis (n=43).
Interventions Treatment was left to the discretion of the emergency physician.
Main outcome measures AMI and mortality.
Results 4% of the patients had STEMI and 16% of the patients had non-STEMI. Patients with AMI had significantly higher levels of hFABP at presentation (p<0.001). Neither the combination with hFABP nor with copeptin increased the diagnostic accuracy of hs-cTnT at admission, quantified by the area under the receiver operating characteristic curve (AUC) (p>0.05). The negative predictive value regarding 90-day, 1-year and 2-year mortality was 100% (99–100), 99% (98–100) and 98% (96–99), respectively, for hFABP levels below the median (p<0.001). The accuracy of hFABP to predict 90-day mortality was moderate (AUC 0.83; 95% CI 0.77 to 0.90).
Conclusions hFABP and copeptin do not improve the diagnosis of patients with chest pain without ST-segment elevation, but may be useful for risk stratification beyond hs-TnT.