Comparison of Usefulness of Heart-Type Fatty Acid Binding Protein Versus Cardiac Troponin T for Diagnosis of Acute Myocardial Infarction

We aimed to assess the additive diagnostic value of measuring the serum levels of soluble human heart-type fatty acid binding protein (H-FABP) in the early diagnosis of acute myocardial infarction (AM!) in unselected patients with chest pain. A total of 97 consecutive patients with acute ischemic-type chest pain were prospectively enrolled and classified according to the American Heart Association/American College of Cardiology guidelines. The test characteristics of H-FABP and cardiac troponin T serum levels at admission revealed a greater sensitivity of H-FABP in the first 4 hours of symptoms (86% vs 42%, p <0.05). Combining H-FABP and cardiac troponin T also improved the sensitivity in the detection of AMI (97% vs 71%, p <0.05) but demonstrated a greater misclassification rate (25% vs 9%, p <0.05). The specificity of H-FABP was poor (65%, 95% confidence interval 58% to 71%). Receiver operating characteristics revealed a poor performance of H-FA BP in patients with non ST-elevation myocardial infarction. Classification tree analysis demonstrated that an H-FABP related improvement in the early definite rule-out of AMI (reduction of false-negative rate from 11% to 3%) was at the expense of an increase in the false-positive rate to 5%. In conclusion, measurement of H-FABP, in addition to cardiac troponin T, serum levels within the first 4 hours of symptoms improves the sensitivity and negative predictive value for the detection of AM I at the cost of test accuracy and precision, especially in patients with non ST-elevation myocardial infarction. (C) 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;105:1-9)