What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Suspected acute coronary syndrome (n=432). Intervention: High-sensitivity troponin T (hsTnT) vs. Heart fatty acid-binding protein (H-FABP). Primary outcome: Diagnostic accuracy for acute coronary syndrome (Area under the ROC curve) (AUC 0.82, 95% CI 0.78-0.87).

January 1, 2011Open Access

Heart Fatty Acid-Binding Protein Offers Similar Diagnostic Performance to High-Sensitivity Troponin T in Emergency Room Patients Presenting With Chest Pain

KIKenji InoueHeart Rhythm Society SSSatoru SuwaInterventional Cardiology HOHiroshi OhtaHokkaido University

Key Result

High-sensitivity troponin T and heart fatty acid-binding protein offered similar overall diagnostic performance for acute coronary syndrome, with AUCs of 0.82 and 0.83 respectively.

Study Design

Type

Cross-Sectional (n=432)

Multicenter

Yes

Structured PICO

Does H-FABP offer similar diagnostic performance to hsTnT for diagnosing acute coronary syndrome in emergency room patients presenting with chest pain?

Population

432 patients (median age 67, 27% female) presenting to the emergency department with chest pain, evaluated for acute coronary syndrome using multiple cardiac biomarkers.

Exposure

Measurement of heart fatty acid-binding protein (H-FABP), myeloperoxidase (MPO), pentraxin 3 (PTX3), and high-sensitivity C-reactive protein (hsCRP) at presentation.

Comparator

Measurement of high-sensitivity troponin T (hsTnT) at presentation.

Outcome

Diagnostic accuracy for acute coronary syndrome (ACS), quantified by the area under the receiver operating characteristic curve (AUC).surrogate

H-FABP offers similar overall diagnostic performance to hsTnT for the early diagnosis of ACS, and combining H-FABP with MPO may improve diagnostic accuracy in patients presenting within 2 hours of symptom onset.

Main Result

Effect estimate: AUC 0.82 (95% CI 0.78-0.87)

Absolute Event Rate: 0.82% vs 0.83%

Limitations

Low prevalence of NSTEMI and UA compared to STEMI due to hospital selection bias
False-positive results in patients with vasospastic angina pectoris and Takotsubo myocarditis

Abstract

BACKGROUND: The aim of the present study was to evaluate the diagnostic accuracy of high-sensitivity troponin T (hsTnT) in patients with suspected acute coronary syndrome (ACS) in comparison to heart fatty acid-binding protein (H-FABP), high-sensitivity C-reactive protein, myeloperoxidase (MPO), and pentraxin 3 (PTX3). METHODS AND RESULTS: Patients (n=432) with chest pain were recruited for the analysis. ACS was diagnosed in 298 patients (69%). The diagnostic accuracy of measurements obtained at presentation, as quantified by the area under the receiver operating curve (AUC), was highest for hsTnT (AUC=0.82; 95% confidence interval CI: 0.78-0.87) and H-FABP (AUC=0.83; 95%CI: 0.78-0.87). Sensitivity (87.9%) and negative likelihood (LH; 0.2) for hsTnT were the highest and lowest, respectively, but H-FABP had the highest specificity (78.5%) and positive LH (3.6). Among patients who presented within 2h after the onset of chest pain, MPO had the highest AUC (0.82; 95%CI: 0.69-0.94). Combined use of H-FABP and MPO measurements yielded a sensitivity of 69.2%, specificity of 84.2%, positive LH of 4.4, and negative LH of 0.4. CONCLUSIONS: The hsTnT assay offers excellent diagnostic performance to rule out ACS, but it is prone to false-positive results. H-FABP offers similar overall diagnostic performance, while the combination of H-FABP and MPO assays may improve the diagnosis of ACS, particularly in patients with recent onset of chest pain.

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