Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study

Ingrid E. M. Bank*, Marieke S. Dekker, Arno W. Hoes, Nicolaas P. A. Zuithoff, Peter W. H. M. Verheggen, Evelyn A. de Vrey, Thierry X. Wildbergh, Leo Timmers, Dominique P. V. de Kleijn, Jan F. C. Glatz, Arend Mosterd

*Corresponding author for this work

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Abstract

Background: Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset. Methods and results: Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect (R)) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test p
Original languageEnglish
Pages (from-to)364-374
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume5
Issue number4
DOIs
Publication statusPublished - Aug 2016

Keywords

  • Acute coronary syndrome (ACS)
  • biomarker
  • heart-type fatty acid binding protein (H-FABP)
  • point-of care test
  • high sensitivity troponin

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