RT Journal Article
SR Electronic
T1 Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 708
OP 714
DO 10.1136/heartjnl-2012-303325
VO 99
IS 10
A1 Reiter, Miriam
A1 Twerenbold, Raphael
A1 Reichlin, Tobias
A1 Mueller, Mira
A1 Hoeller, Rebecca
A1 Moehring, Berit
A1 Haaf, Philip
A1 Wildi, Karin
A1 Merk, Salome
A1 Bernhard, Denise
A1 Mueller, Christa Zellweger
A1 Freese, Michael
A1 Freidank, Heike
A1 Campodarve Botet, Isabel
A1 Mueller, Christian
YR 2013
UL http://heart.bmj.com/content/99/10/708.abstract
AB 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.