Heart-type fatty acid binding protein as an early marker for myocardial infarction: systematic review and meta-analysis. Issue 4 (16th May 2012)

• Record Type: Journal Article
• Authors: Carroll, Christopher; Al Khalaf, Mohamad; Stevens, John W; Leaviss, Joanna; Goodacre, Steve; Collinson, Paul O; Wang, Jenny
• Is Part Of: Emergency medicine journal. Volume 30:Issue 4(2013)
• Page Start: 280
• Page End: 286
• Publication Date: 2012-05-16
• Subjects: Myocardial infarction -- cardiac markers -- diagnosis -- meta-analysis -- law -- thromboembolic disease -- cost effectiveness -- research -- acute coronary syndrome -- heart failure; Emergency medicine -- Periodicals; 616.02505
• DOI: 10.1136/emermed-2012-201174
• Languages: English
• ISSNs: 1472-0205

Abstract

Abstract : Background: Heart-type fatty acid binding protein (H-FABP) has been proposed as an early biomarker of myocardial infarction (MI). The authors aimed to undertake a systematic review and meta-analysis to estimate the early sensitivity and specificity of quantitative and qualitative H-FABP assays. Methods: The authors undertook a systematic search using electronic databases, citation lists and expert contacts to identify all diagnostic cohort studies of patients presenting with suspected acute coronary syndrome that compared H-FABP at presentation to a reference standard based on the Universal definition of MI. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Meta-analysis was conducted using Bayesian Markov chain Monte Carlo simulation. Results: The authors included eight studies of quantitative H-FABP and nine studies of qualitative H-FABP. The summary estimates of sensitivity and specificity were 81% (95% prediction interval 50% to 95%) and 80% (26% to 98%) respectively for the quantitative assays and 68% (11% to 97%) and 92% (20% to 100%) respectively for the qualitative assays. Four studies reported the sensitivity of troponin and H-FABP at presentation in which the combination was considered positive if either test was positive. The addition of H-FABP to troponin increased sensitivity from 42–75% to 76–97% but decreased specificity from 94–100% to 65–93%. Conclusion: H-FABP has modest sensitivity and specificity for MI at presentation but estimates are subject to substantial uncertainty and primary data are subject to substantial heterogeneity. H-FABP may have a role alongside troponin in improving early sensitivity but comparison with high sensitivity troponin assays is required.