Diagnostic Value Of Heart-fatty Acid-binding Protein For Myocardial Infarction In The Early Period Of Perioperative

ObjectiveTo evaluate the diagnostic value of H-FABP for the myocardial infarction in the early period post off-pump coronary artery bypass grafting (OPCAB),and determine the time and diagnostic cut-off point of H-FABP increasing over normal threshold for the myocardial infarction in perioperative period of off-pump coronary artery bypass grafting(OPCAB), and the prognostic value for myocardial infarction in the early period of perioperative after OPCAB.Methods59 patients (male 37 and female 22, from 46 to 83 years old) who were the first time to undergoing OPCAB were included in this study. Serial venous blood samples were taken after induction of anesthesia, the OPCAB finished (after the last anastomosis), entered ICU,2h,4h and 8h after the patient entered ICU, day 1 and 2 postoperative to test H-FABP. The cTnI and CK-MB were tested at 4h and 8h, after entering ICU, day 1 and 2 postoperative. Patients were divided into 3 groups by the level of cTnl at 8h after they entered ICU: normal group, myocardial injury group and myocardial infarction group, to observe and analyse the the time of H-FABP increasing over normal threshold for the myocardial infarction in perioperative period of OPCAB. Then the normal group was combined with myocardial injury group, patients were divided into two groups: non-infarction group (group A), myocardial infarction group (group B). The diagnostic test and receiver operating characteristic (ROC)curves were applied to determine the cutoff point of the H-FABP. Then according to the level of H-FABP, the patients were divided into two new groups: group Al (the level of H-FABP<cutoff point) and group B1(the level of H-FABP≧ cutoff point), to compare the amount of the vasoactive drugs and the time of mechanical ventilation support and retention in the ICU between the two groups.Results(1) The level of H-FABP released was significantly higher in the myocardial infarction group than normal group and myocardial injury group (P<0.01). H-FABP, cTnI and CK-MB increased in different degree, but the release of H-FABP is earlier (finished OPCAB) (P<0.05) than cTnI and CK-MB, and it peaked early at 2h after entered ICU(P<0.01), began to decrease at 4h after entered ICU and returned to baseline at 1d postoperative, while the cTnI and CK-MB peaked at postoperative day 1 and 8h after entered ICU respectively, and maintained in higher level at postoperative day 2. (2) The area under the ROC (AUC) of cTnI1,H-FABP2,H-FABP3and H-FABP4 were 0.758,0.839,0.884 and 0.833. Compared with cTnI, H-FABP has better diagnostic value for myocardial infarction in the early period of perioperative after OPCAB. The Cut-Off value of cTnI1,H-FABP2,H-FABP3 and H-FABP4 were 1.015 ng/ml,21.93 ng/ml,20.53 ng/ml and 19.7 ng/ml. (3) The sensitivity of cTnI1,H-FABP2,H-FABP3and H-FABP4 were 53.8%,92.3%,92.3% and 84.6% when tested separately, and H-FABP2,H-FABP3 were the highest comparing to cTnI1 and H-FABP4,while the diagnostic value was significantly higher when united. (4) The amount of the vasoactive drugs and the time of mechanical ventilation support and retention in the ICU of group B1 were significantly greater than group A1 (P<0.01)ConclusionsH-FABP can be used as a diagnosis biomarker for the perioperative myocardial infarction (PMI) in the early period, it has better diagnostic value for myocardial infarction in early period than the "gold standard" cTnI, and it can evaluate the prognosis of the patients in the early period post OPCAB.