What does this research mean for the field?

Elevated heart-type fatty acid-binding protein independently predicts 1-year all-cause mortality after acute coronary syndrome incrementally to troponin, hs-CRP, and GRACE risk factors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess the predictive value of heart-type fatty acid-binding protein (H-FABP) for all-cause mortality following acute coronary syndrome (ACS).

June 5, 2026Journal of the American College of Cardiology

Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Troponin Values

Q: What are the key findings of this study?

Elevated heart-type fatty acid-binding protein (highest vs lowest quartile) strongly predicted 1-year all-cause mortality in patients with acute coronary syndrome (HR 4.88; 95% CI 2.67-8.93; P<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Acute Coronary Syndrome (n=1448). Intervention: Heart-type fatty acid-binding protein (H-FABP) vs. Lowest H-FABP quartile (Q1). Primary outcome: All-cause mortality at 1 year (HR 4.88, 95% CI 2.67-8.93, p=<0.001).

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Key result

Elevated H-FABP linked to ~388% greater 1-year mortality risk in ACS.

HR 4.88
95% CI 2.67-8.93
P<0.001
n=1,448

Why the study?

Because heart-type fatty acid-binding protein is released following myocardial ischemia and necrosis, its role in predicting all-cause mortality after acute coronary syndrome needed to be determined.

Does heart-type fatty acid-binding protein (H-FABP) level predict 1-year all-cause mortality in patients admitted with acute coronary syndrome?

Population

1,448 patients admitted to hospital with ACS

Comparison

H-FABP levels measured 12 to 24 h after symptom onset

Design

Prospective observational study

Follow-up

12 months

Authors

NKNiamh KilcullenLeeds Teaching Hospitals NHS Trust KVKarthik ViswanathanLeeds General Infirmary RDRajiv DasNewcastle upon Tyne Hospitals NHS Foundation Trust

Discussion

Member takes

Key expert perspectives

Captured external expert commentary on this paper, strongest first. Original sources are linked where available.

AH Alistair HallProfessor of Clinical Cardiology, University of Leeds

“The H-FABP test is a major advance on what we had before. It appears to be able to detect milder and earlier degrees of heart injury than do current tests which detect heart cell death.”

University of LeedsNews Coverage

PW Peter WeissbergMedical Director, British Heart Foundation

“This new blood test would appear to be able to more accurately identify patients with heart damage at an earlier course of their illness. If further research confirms its superiority over current tests, it has the potential to improve diagnosis and identify those people who require intensive investigation and treatment to prevent further problems.”

British Heart FoundationNews Coverage

Implication

May refine ACS mortality risk stratification beyond GRACE; leaves open prospective validation before clinical adoption.

Key Points

To assess the predictive value of heart-type fatty acid-binding protein (H-FABP) for all-cause mortality following acute coronary syndrome (ACS).
Prospective observational study with 12 months follow-up
Measured H-FABP in 1,448 ACS patients within 12 to 24 hours of symptom onset
Conducted multivariable analyses using GRACE variables, troponin I, and hs-CRP.
After 12 months, 296 patients died.
H-FABP quartiles predicted mortality: Q2 HR 2.32 (95% CI 1.25 to 4.30; p=0.007), Q3 HR 3.17 (95% CI 1.73 to 5.82; p<0.001), Q4 HR 4.88 (95% CI 2.67 to 8.93; p<0.001).
Stable angina patients with H-FABP <5.8 microg/l had 2.1% mortality, compared to 22.9% for those above this cutoff.

Study Design

Type

Observational (n=1,448)

Structured PICO

Does heart-type fatty acid-binding protein (H-FABP) level predict 1-year all-cause mortality in patients admitted with acute coronary syndrome?

Population

1,448 patients admitted to hospital with acute coronary syndrome, followed for 12 months.

Exposure

Heart-type fatty acid-binding protein (H-FABP) measurement 12 to 24 h after onset of symptoms

Comparator

Lower quartiles of H-FABP or H-FABP <5.8 microg/l

Outcome

All-cause mortality 1 year after index hospital admissionhard clinical

Main Result

Hazard Ratio: 4.88 (95% CI 2.67–8.93)

p-value: p=<0.001

H-FABP measured 12-24 hours after symptom onset strongly predicts 1-year all-cause mortality in ACS patients, providing additive prognostic value to GRACE risk factors, troponin, and hs-CRP.

Cite This Study

Kilcullen et al. (2007) conducted an observational in Acute Coronary Syndrome (n=1,448). Heart-type fatty acid-binding protein (H-FABP) vs. Lowest H-FABP quartile (Q1) was evaluated on All-cause mortality at 1 year (HR 4.88, 95% CI 2.67-8.93, p=<0.001). Elevated heart-type fatty acid-binding protein (highest vs lowest quartile) strongly predicted 1-year all-cause mortality in patients with acute coronary syndrome (HR 4.88; 95% CI 2.67-8.93; P<0.001).

synapsesocial.com/papers/6a22e8e4b1e87d0ee4e6c01a https://doi.org/10.1016/j.jacc.2007.08.021

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Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Troponin Values

Discussion

Member takes

Key expert perspectives

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Troponin Values

Discussion

Member takes

Key expert perspectives

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider