• Miriam Reiter, Raphael Twerenbold, Tobias Reichlin, Mira Mueller, Rebecca Hoeller, Berit Moehring, Philip Haaf, Karin Wildi, Salome Merk, Denise Bernhard, Christa Zellweger Mueller, Michael Freese, Heike Freidank, Isabel Campodarve Botet, and Christian Mueller.
• Department of Internal Medicine, University Hospital, Basel, Switzerland.
• Heart. 2013 May 1;99(10):708-14.

ObjectiveTo investigate the diagnostic and prognostic role of heart-type fatty acid-binding protein (hFABP) compared with copeptin and in addition to high-sensitivity cardiac troponin T (hs-cTnT) in patients with chest pain suspected of acute myocardial infarction (AMI).DesignDiagnostic and prognostic performances of hFABP, copeptin and hs-cTnT were evaluated and compared. The final diagnosis was adjudicated by two independent cardiologists.SettingThis prospective observational multicentre study took place in four primary and one secondary hospital from April 2006 to September 2009.PatientsWe enrolled 1247 consecutive patients with suspected AMI to the emergency department. For analysis, patients were included, if baseline levels for hs-cTnT and hFABP were available (n=1074), patients with ST-segment elevation myocardial infarction (STEMI) were excluded for the diagnostic analysis (n=43).InterventionsTreatment was left to the discretion of the emergency physician.Main Outcome MeasuresAMI and mortality.Results4% of the patients had STEMI and 16% of the patients had non-STEMI. Patients with AMI had significantly higher levels of hFABP at presentation (p<0.001). Neither the combination with hFABP nor with copeptin increased the diagnostic accuracy of hs-cTnT at admission, quantified by the area under the receiver operating characteristic curve (AUC) (p>0.05). The negative predictive value regarding 90-day, 1-year and 2-year mortality was 100% (99-100), 99% (98-100) and 98% (96-99), respectively, for hFABP levels below the median (p<0.001). The accuracy of hFABP to predict 90-day mortality was moderate (AUC 0.83; 95% CI 0.77 to 0.90).ConclusionshFABP and copeptin do not improve the diagnosis of patients with chest pain without ST-segment elevation, but may be useful for risk stratification beyond hs-TnT.

26 keywords...

hide…