Key result
The H-FABP automated assay showed a diagnostic efficacy of 98.70% for acute myocardial infarction compared to 89.47% for myoglobin, with a non-significant difference in AUC (p=0.079).
Why the study?
Does a fully automated H-FABP assay improve diagnostic accuracy for acute myocardial infarction compared to myoglobin in patients presenting to the emergency department with chest pain?
Cross-Sectional (n=77)
No
Does a fully automated H-FABP assay improve diagnostic accuracy for acute myocardial infarction compared to myoglobin in patients presenting to the emergency department with chest pain?
Effect estimate: Difference in AUC 0.061 (95% CI -0.007 to 0.128)
Absolute Event Rate: 98.7% vs 89.47%
p-value: p=0.079
A fully automated H-FABP assay demonstrated excellent diagnostic accuracy for the early detection of acute myocardial infarction in emergency department patients, performing at least as well as myoglobin.
May support automated H-FABP as myoglobin alternative for AMI; hypothesis-generating, requires prospective validation before ED adoption.
BACKGROUND: The accurate and rapid recognition of myocardial injury in patients presenting in the emergency department (ED) with chest pain continues to be a clinical challenge. Heart-type fatty acid-binding protein (H-FABP) appears to be one of the best candidates among the new early cardiac markers studied. METHODS: We evaluated the analytical characteristics of a new quantitative and fully automated H-FABP assay (Randox Laboratories Ltd., Crumlin, UK) and compared its clinical performance with respect to the myoglobin (Myo) assay (Dade Behring, Milan, Italy). A precision study was carried out by testing three levels of quality control (QC) material and two in-house pool (P) samples. To test the accuracy of H-FABP determinations in plasma (lithium-heparin) samples, H-FABP concentrations measured in a set of matched sera and plasma samples were compared. A total of 77 non-consecutive patients (51 males and 26 females; 62+/-16 years) who presented to the ED with chest pain suggesting myocardial ischemia were enrolled. The patients were classified into two groups (acute myocardial infarction, n=22; non-acute myocardial infarction, n=55) on the basis of the discharge diagnosis. RESULTS: The between-day imprecision for three levels of control material and serum pool samples was 6.26%-8.04% (range 2.32-44.03 microg/L) and 9.03%-12.63% (range 11.85-65.13 microg/L), respectively. In the serum vs. plasma study, bias was +0.178 (95% CI -0.033 to +0.389). The best cut-off and the associated diagnostic efficacy were 95 microg/L and 89.47% for Myo and 5.09 microg/L and 98.70% for H-FABP, respectively. CONCLUSIONS: H-FABP determination in patients with ischemic symptoms may be a more reliable early indication of cardiac damage than myoglobin.
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Zaninotto et al. (2006) conducted a cross-sectional in Chest pain suggesting myocardial ischemia (n=77). H-FABP automated assay vs. Myoglobin assay was evaluated on Diagnostic efficacy for acute myocardial infarction (Difference in AUC 0.061, 95% CI -0.007 to 0.128, p=0.079). The H-FABP automated assay showed a diagnostic efficacy of 98.70% for acute myocardial infarction compared to 89.47% for myoglobin, with a non-significant difference in AUC (p=0.079).
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