Utility of Heart-Type Fatty Acid Binding Protein in Early Diagnosis of Acute Coronary Syndrome

Background: Early diagnosis of the patients presenting with suspected acute coronary syndrome using novel cardiac biomarkers, help to avoid delay in administering treatment, and to prevent inadvertent discharge of patients with acute myocardial infarction.Objective: To determine the diagnostic accuracy of rapid Heart-type Fatty Acid-Binding Protein (H-FABP) test in patients suspected to have Acute Coronary Syndrome (ACS).Patients and Methods: Ninety patients admitted with chest pain of possible or definite cardiac etiology (within 24 h duration), irrespective of (ECG) changes, were subjected to detailed and full history taking and thorough clinical examination, 12 lead ECG, and echocardiography, full laboratory investigation, including cardiac enzymes, troponin, and H-FABP. All patients underwent coronary angiography.Results: Mean patient age was 56 years (SD 12), 88% was male, and 80 patients (89%) were diagnosed with ACS. The H-FABP test was performed within 24h after symptom onset. The positive predictive value (PPV) of H-FABP was 73.6%; the Negative Predictive Value (NPV) was 100% (95% CI 0.660-0.891). Sensitivity was 92.3% and specificity 56%. And the discriminatory power for H-FABP was higher as indicated by AUC 0.776 versus Troponin (0.675) within 4hrs after coronary occlusion and symptoms.Conclusion: H-FABP is an early sensitive marker for diagnosis of myocardial infarction with higher sensitivity during the initial 4hrs from chest pain onset when compared with conventional troponin; therefore H-FABP can be used to rule out myocardial infarction during an early stage of chest pain presentation.