Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality and Re-Infarction in Consecutive Patients With Suspected Acute Coronary Syndrome Who Are Troponin-Negative
Key result
Elevated H-FABP linked to ~2.6-fold higher risk of death or recurrent MI in suspected ACS.
- adjusted HR 2.62
- 95% CI 1.30-5.28
- P=0.007
- n=955
Figures
Why the study?
The prognostic value of heart fatty acid-binding protein (H-FABP) in addition to third-generation troponin assays in low- to intermediate-risk suspected ACS patients was not established.
Does elevated H-FABP concentration predict death or myocardial infarction in patients with suspected acute coronary syndrome?
Key Points
- To determine the prognostic value of measuring heart fatty acid-binding protein (H-FABP) in addition to third-generation troponin in patients with suspected acute coronary syndrome.
- Recruited 1,080 consecutive patients admitted to the hospital with suspected acute coronary syndrome over 46 weeks.
- Excluded patients with ST-segment elevation and new left bundle branch block, leaving 955 patients for analysis.
- Measured Siemens Advia Ultra-TnI and Randox Evidence H-FABP on blood samples obtained 12 to 24 h from symptom onset, with a minimum follow-up of 12 months (median 18 months).
- The primary endpoint of death or readmission with myocardial infarction occurred in 96 of 955 patients (10.1%) over a median follow-up of 18 months.
- H-FABP concentration >6.48 microg/l independently predicted death or myocardial infarction after multivariate adjustment (adjusted HR: 2.62, 95% CI: 1.30 to 5.28, p = 0.007).
- Among troponin-negative patients (79.2% of the cohort), an H-FABP concentration >6.48 microg/l identified individuals at very high risk for adverse outcomes independent of age and serum creatinine.
Study Design
Type
Cohort (n=955)
Structured PICO
Does elevated H-FABP concentration predict death or myocardial infarction in patients with suspected acute coronary syndrome?
P
Population
955 patients with suspected acute coronary syndrome without ST-segment elevation or new LBBB, followed for a median of 18 months.
E
Exposure
Elevated heart-type fatty acid-binding protein (H-FABP) concentration (>6.48 microg/l) measured 12 to 24 hours from symptom onset
C
Comparator
H-FABP concentration ≤6.48 microg/l
O
Outcome
Composite of death or readmission with myocardial infarction after a minimum follow-up period of 12 months (median 18 months)hard clinical
Main Result
Hazard Ratio: 2.62 (95% CI 1.3–5.28)
p-value: p=0.007
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Presently, where Troponin is used on its own and generates a negative result, patients are frequently sent home. However, our study found that a significant number of these people are subsequently found to be at high risk of having a heart attack over the coming months, if they have not done so already. H-FABP can help to identify these high risk patients.”
Implication
H-FABP provides additive prognostic value to troponin for identifying high-risk patients among those with suspected ACS, particularly when troponin is negative.
Abstract
Objectives The purpose of this study was to establish the prognostic value of measuring heart fatty acid-binding protein (H-FABP) in patients with suspected acute coronary syndrome (ACS) (in particular, low- to intermediate-risk patients), in addition to troponin measured with the latest third-generation troponin assay. Background We have previously shown that H-FABP is a useful prognostic marker in patients with proven ACS. Methods Patients (n = 1,080) consecutively admitted to the hospital with suspected ACS were recruited over 46 weeks. Siemens Advia Ultra-TnI (Siemens Healthcare Diagnostics, Newbury, United Kingdom) and Randox Evidence H-FABP (Randox Laboratories, Ltd., Co., Antrim, United Kingdom) were analyzed on samples collected 12 to 24 h from symptom onset. After exclusion of patients with ST-segment elevation and new left bundle branch block, 955 patients were included in the analysis. Results The primary outcome measure of death or readmission with myocardial infarction after a minimum follow-up period of 12 months (median 18 months) occurred in 96 of 955 patients (10.1%). The H-FABP concentration was an independent predictor of death or myocardial infarction, after multivariate adjustment. Patients with H-FABP concentrations >6.48 microg/l had significantly increased risk of adverse events (adjusted hazard ratio: 2.62, 95% confidence interval: 1.30 to 5.28, p = 0.007). Among troponin-negative patients (which constituted 79.2% of the cohort), the aforementioned cutoff of 6.48 microg/l identified patients at very high risk for adverse outcomes independent of patient age and serum creatinine. Conclusions We have demonstrated that the prognostic value of elevated H-FABP is additive to troponin in low- and intermediate-risk patients with suspected ACS. Other studies suggest that our observations reflect the value of H-FABP as a marker of myocardial ischemia, even in the absence of frank necrosis.
Discussion
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Cite This Study
Kilcullen et al. (2010) conducted a cohort in Suspected acute coronary syndrome (n=955). Elevated H-FABP (>6.48 microg/l) vs. H-FABP ≤6.48 microg/l was evaluated on Composite of death or readmission with myocardial infarction (adjusted HR 2.62, 95% CI 1.30-5.28, p=0.007). Elevated H-FABP concentrations (>6.48 microg/l) significantly increased the risk of death or readmission with myocardial infarction by 2.62-fold compared to lower levels in patients with suspected acute coronary syndrome.