Point-of-care heart-type fatty acid binding protein versus high-sensitivity troponin T testing in emergency patients at high risk for acute coronary syndrome. Issue 2 (April 2016)

• Record Type: Journal Article
• Authors: Kellens, Sebastiaan; Verbrugge, Frederik H; Vanmechelen, Maxime; Grieten, Lars; Van Lierde, Johan; Dens, Joseph; Vrolix, Mathias; Vandervoort, Pieter
• Is Part Of: European heart journal. Volume 5:Issue 2(2016)
• Page Start: 177
• Page End: 184
• Publication Date: 2016-04
• Subjects: Acute coronary syndrome -- FABP3 protein -- myocardial infarction -- prognosis; 616.1205
• DOI: 10.1177/2048872615570221
• Languages: English
• ISSNs: 2048-8726

Abstract

Background: High-sensitivity cardiac troponin testing is used to detect myocardial damage in patients with acute chest pain. Heart-type fatty acid binding protein (H-FABP) may be an alternative, available as point-of-care test. Methods: Patients ( n =203) referred by general practitioners for suspected acute coronary syndrome or presenting with typical chest pain and one major cardiovascular risk factor at the emergency department were prospectively included in a single-centre cohort study. High-sensitivity cardiac troponin T (hs-TnT) and point-of-care H-FABP testing were concomitantly performed at admission and after 6h. Results: Maximal hs-TnT levels above the 99th percentile were observed in 152 patients (75%) with 127 (63%) fulfilling criteria for myocardial infarction. Upon admission, hs-TnT and H-FABP were associated with an area under the curve (95% CI) of 0.83 (0.77–0.89) and 0.79 (0.73–0.85), respectively, to predict myocardial infarction, which increased to 0.93 (0.90–0.97) and 0.88 (0.84–0.93), respectively, after 6h. The diagnostic accuracy for non-ST-segment elevation myocardial infarction was somewhat lower with an area under the curve (95% CI) of 0.80 (0.72–0.87), 0.90 (0.84–0.96), 0.73 (0.64–0.81) and 0.77 (0.67–0.86), respectively. When assessment was performed within 3h of chest pain onset, diagnostic accuracy of H-FABP versus hs-TnT was similar. Each standard deviation increase in admission H-FABP was associated with a 68% relative risk increase of all-cause mortality ( p -value=0.027) during 666±155 days of follow-up. Conclusions: Point-of-care H-FABP testing has lower diagnostic accuracy compared with hs-TnT assessment in patients with high pre-test acute coronary syndrome probability, but might be of interest when assessment is possible early after chest pain onset.