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.
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.
['Kellens|Sebastiaan|S|', 'Verbrugge|Frederik H|FH|', 'Vanmechelen|Maxime|M|', 'Grieten|Lars|L|', 'Van Lierde|Johan|J|', 'Dens|Joseph|J|', 'Vrolix|Mathias|M|', 'Vandervoort|Pieter|P|']
D054058:Acute Coronary Syndrome D000368:Aged D019540:Area Under Curve D015331:Cohort Studies D042241:Early Diagnosis D004636:Emergency Service, Hospital D000074026:Fatty Acid Binding Protein 3 D050556:Fatty Acid-Binding Proteins D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D019095:Point-of-Care Systems D012680:Sensitivity and Specificity D020107:Troponin T
Acute coronary syndrome myocardial infarction FABP3 protein prognosis