Author + information
- Received August 13, 2009
- Revision received November 30, 2009
- Accepted December 17, 2009
- Published online June 8, 2010.
- Karthik Viswanathan, MD*,
- Niamh Kilcullen, MD*,
- Christine Morrell*,
- Sue J. Thistlethwaite*,
- Mohan U. Sivananthan, MD†,
- Tajek B. Hassan, MD§,
- Julian H. Barth, MD‡ and
- Alistair S. Hall, MD, PhD*,* ()
- ↵*Reprint requests and correspondence:
Dr. Alistair S. Hall, C-NET Group, Clinical Cardiology, G Floor, Jubilee Building, The General Infirmary at Leeds, Leeds, LS1 3EX Yorkshire, United Kingdom
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 μg/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 μg/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.
Parts of this work were supported by a grant from the British Heart Foundationand free troponin I assays given by Siemens Healthcare Diagnostics. Drs. Hall, Barth, and Sivananthan received grants from the British Heart Foundationand unrestricted grants from Medtronic, Sanofi-Aventis, Pfizer, Siemens Healthcare diagnostics, and Randox Laboratoriesto support this research.
- Received August 13, 2009.
- Revision received November 30, 2009.
- Accepted December 17, 2009.
- American College of Cardiology Foundation