| Serum biochemical markers are playing an important role in early diagnosing acute myocardial infarction (AMI) nowadays. The common biochemical markers used in clinic now are known as isoenzyme MB of creatine kinase(CK-MB), cardiac troponin (cTn) and myoglobin (MYO).CK-MB and cTn have low sensitivity in the early phase ofAMI; MYO has a rather high sensitivity in the early phase of AMI, but its specificity is not so satisfied. Therefore, the common biochemical markers' contributions are very limited in early diagnosing AMI. Heart-type fatty acid-binding protein(H-FABP) is a kind of cardiac muscle specialized protein which has a low molecular weight. It can arrive into circulation soon after the damage of myocardial cell. The serum concentration of H-FABP begins to step up at 1-3 hours, peaks at 4-8 hours and becomes normal 12 hours after AMI. Serum concentration can be quantified easily, quickly and reliably using ELISA kit. Therefore H-FABP has completed the 6 standards of biochemical markers in early diagnosing AMI which was raised by Puleo and Roberts. It is generally believed that H-FABP has superiority in chronergy sensitivity and specificity, and it is a fine biochemical marker in early diagnosing AMI.The researches have become more and more on clinic diagnostic value of H-FABP in AMI and the comparison with the traditional biochemical markers such as CK-MB, cardiac troponin (cTn), cardiac troponin I (cTnI)and myoglobin (MYO).But the investigation's design and value are different and controversial.How is the value of H-FABP in early diagnosing AMI? Is it necessary to be included in the combined assay of AMI? Can it bring more information to doctors? Can it bring unwanted burden to patients? There is no meta-analysis, systematic review or Health Technology Assessment to get a conclusion.Nowadays, many lab examinations have been used in the clinic without sufficient assessment and brought huge burden to the patients, increased the misleadings in clinical diagnosis and treatment. At the situation of high level of medical cost, how to evaluate and choose the proper examination and reduce the examination cost are the problem that have to be paid more attention to and solved by each level of medical staff, especial the Health Ministry. We performed this systematic review to evaluate the diagnostic efficacy of H-FABP in early diagnosing AMI.ObjectiveAccording to the evidences of using H-FABP in early diagnosing AMI throughout the world, the author systematically analysis the accuracy of using H-FABP in early diagnosing AMI in order to perform the evidence of diagnosis and treatment guideline making by the Health Ministry or admission control, of the reference for the examination person refreshing the items, of the clinical decision making by doctors to choose the H-FABP in early diagnosing AMI. The main researches include:Evaluate the quality of articles on the using H-FABP in early diagnosing AMI, find the resource of variation and bias, make some suggestions for the future research.The efficacy, sensitivity and specificity of the H-FABP in early diagnosing AMI.The chronergy of the H-FABP in early diagnosing AMI.Can the H-FABP make up for the shortcoming and disadvantages of traditional biochemical markers used nowadays in screening and diagnosing AMI?MethodsWe included the researches about H-FABP in diagnosing AMI (including the studies H-FABP in Comparison with the cardiac marks of cTnT , CK-MB or MYO).Retrieve MEDLINE,EMBASE,OVID,CBMDISC,Chinese biomedical literature database,CNKI,VIP and CACP. The retrieval time was set as "January 1970 to November 2006". Meanwhile, the published relevant journals were also searched manually from 1980 to 2006.Fourfold table data [true positive (a), false positive(b), false negative(c) and true negative(d)]was achieved by original paper, calculating .Assess the quality of the articles and the possibility of bias using quality assessment of diagnostic accuracy studies(QUADAS)Settle the groups by research time identified before. Carry out the summary OR analysis and heterogeneity test of different groups by Metadisc software. Thereafter, the summary sensitivity, specificity, accuracy, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ration were calculated. Systematic ROC(SROC) curve was then built and the area under the curve was calculated.ResultsTotally, 11 studies ( n=1352 ) were included, the pooled sensitivity of the studies was 0.88(95%CI:0.84-0.89),and the pooled specificity was 0.75(95%CI:0.71-.0.78), areas under the Summary ROC curve was 0.91. SE=0.0164. Results of 0-3h group ,which including 5 studies ( n=396 ) , were homogeneous ( P= 0.49, I~2=0 ) , summary sensitivity: 0.86(95%CI:0.80-0.91), summary specificity: 0.76(95%CI:0.80-0.91), areas under the curve: 0.88. SE=0.0323. Conclusion As far as we know, H-FABP has an acceptable diagnosis accuracy for AMI patients presenting within 3 h after onset of symptoms, and has a high diagnostic efficacy for the group within 12 h after onset of symptoms. H-FABP can be a new marker for the early diagnosis of AMI.Diagnosis efficacy comparison between H-FABP and cTnT:Chest pain 0-6 hour: five articles included. The Area under curve (AUC) of Systematic ROC(SROC) in H-FABP and cTnT groups are 0.8883 and 0.6456 respectively. The integrative sensitivity in H-FABP and cTnT groups are 0.839 (0.784- 0.886),0.448(0.383- 0.515) respectively. The integrative specificity in H-FABP and cTnT groups are 0.731 (0.680- 0.779),0.886(0.847- 0.918) respectively.Chest pain 0-12 hour: six articles included. The AUC of SROC in H-FABP and cTnT groups are0.9099 and 0.6456 respectively. The integrative sensitivity in H-FABP and cTnT groups are 0.839 0.882 (0.841- 0.915),0.526(0.470- 0.581) respectively. The integrative specificity in H-FABP and cTnT groups are 0.700 (0.654- 0.743),0.851 (0.813-.884) respectively.Diagnosis efficacy comparison between H-FABP and MYO:Chest pain 0-3 hour: three articles included. The The AUC of SROC in H-FABP and cTnT groups are 0.8458(SE=0.0446) and 0.7335 (SE=0.0578) respectively. The integrative sensitivity in H-FABP and cTnT groups are 0.84(0.76- 0.899), 0.55(0.457- 0.641) respectively. The integrative specificity in H-FABP and cTnT groups are0.65 (0.51- 0.78),0.69(0.537- 0.813) respectively.Chest pain 0-6 hour: six articles included. The The AUC of SROC in H-FABP and cTnT groups are 0.9039 and 0.8384 respectively. The integrative sensitivity in H-FABP and cTnT groups are 0.869 (0.834- 0.899),0.734(0.690- 0.775) respectively. The integrative specificity in H-FABP and cTnT groups are 0.751 (0.705- 0.793),0.753(0.707- 0.794) respectively.Chest pain 0-12 hour: six articles included. The AUC of SROC in H-FABP and cTnT groups are 0.9154 and 0.8439 respectively. The integrative sensitivity in H-FABP and cTnT groups are 0.867 (0.828- 0.900),0.761(0.713- 0.804) respectively. The integrative specificity in H-FABP and cTnT groups are 0.832 (0.786- 0.871),0.798(0.749- 0.840) respectively.Diagnosis efficacy comparison between H-FABP and CK-MB:Chest pain 0-6 hour: four articles included. The The AUC of SROC in H-FABP and cTnT groups are 0.9175 and 0.8158 respectively. The integrative sensitivity in H-FABP and cTnT groups are 0.873 (0.818- 0.916),0.289(0.227- 0.358) respectively. The integrative specificity in H-FABP and cTnT groups are 0.842 (0.788- 0.888),0.921 (0.876- 0.953) respectively.Chest pain 0-12 hour: five articles included. The AUC of SROC in H-FABP and cTnT groups are 0.9132 and 0.7825 respectively. The integrative sensitivity in H-FABP and cTnT groups are 0.877 (0.833- 0.913),0.341(0.785- 0.399) respectively.The integrative specificity in H-FABP and cTnT groups are 0.827 (0.775- 0.871),0.919(0.879- 0.949) respectively.Conclusions:It is generally believed that H-FABP has superiority in chronergy sensitivity and specificity, and it is a fine biochemical marker in early diagnosing AMI. We performed this systematic review to evaluate the diagnostic efficacy of H-FABP in early diagnosing AMI.The integrative diagnosis efficiency findings show that H-FABP has better diagnosis sensitivity ( 86%-97% ) and better diagnosis efficiency in 0-3hour group. The AUC of SROC=0.8892. The integrative sensitivity is 86%.The diagnosis efficiency comparisons between H-FABP, cTnT, MYO and CK-MB show that H-FABP has better sensitivity and integrative diagnosis efficiency than biochemical markers nowadays used in diagnosing AMI. The integrative specificity is less than cTnT and CK-MB, and has no significant difference.Based on the available researches, H-FABP has better sensitivity and integrative diagnosis efficiency than MYO in 0-3 hour from chest pain onset, and will replace MYO in early screening AMI. While, H-FABP has not superiority in specificity in comparison with cTnT, CK-MB, even MYO, it cannot replace cTnT in final diagnosing AMI.
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