Evaluation Of The Diagnostic Performance Of Heart-type Fatty Acidbinding Protein In The Early Of Acute Coronary Syndrome

Purpose: Currently the incidence of acute coronary syndrome (ACS) isincreasing year by year, and more and more young people suffering fromacute coronary syndrome.For acute coronary syndrome, especially acutemyocardial infarction (AMI),rapidly and correctly diagnose,sufficiently openobstructed coronary, and prompt effective blood reperfusion are the key tosave the lives and improve the prognosis.We assessed the diagnosticperformance of heart-type fatty acid binding protein(H-FABP) comparison oftroponin I (cTnI), Myoglobin (MYO),creatine kinase (CK),creatine kinaseisoenzyme(CK-MB), B-type natriuretic peptide precursor(NT-proBNP) andcTnI combined with H-FABP or MYO, and explored the diagnostic value ofH-FABP of ACS in different times within12hours.Method: We designed a single center study coordinated by The SecondHospital of Hebei Medical University’s emergency department from Jule2012through September2013. Patient recruitment was prospective, but biomarkeranalysis was retrospective. Patients with chest pain who consented and did notmeet trial exclusion criteria were arranged for a series of cardiac biomarkerson admission. Exclusion criteria:(1) patients with a serious valvular heartdisease, cardiomyopathy, myocarditis, pericarditis, and primary pulmonaryhypertension;(2) patients with a history of myocardial infarction;(3) patientswith malignant tumors;(4) patients with impaired renal function or liverdysfunction;(5) the fever patients,or known as chronic or acute systemicinflammatory disease or infection;(6) patients after cardio-pulmonaryresuscitation;(7) patients receiving anticoagulation therapy for thromboticdiseases within4weeks;(8) patients with trauma or surgery within4weeks;(9)on admission period more than12hours;(10) patients disagreed toparticipate in this study.According to the inclusion criteria and exclusion criteria, samples were obtained from189out of173patients who got chestpain within12hours enrolled in the study, and there are122cases of male,51female cases,average age is54.08±10.173years old. According to the onsettime on admission,all the patients are divided into three groups:0-3hours,3-6hours and6-12hours.And based on the inclusion criteria all the patientsdivided into four groups: ST-segment elevation myocardial infarction group(STEMI,group A), non-ST segment elevation myocardial infarction(NSTEMI,group B), unstable angina (UA,group C), and non-cardiac chestpain (NCCP,group D).Venous blood samples are drawn from elbow veinabout5ml on admission immediately and send to the emergency laboratory ofthe Second Hospital of Hebei Medical University,and measure H-FABP, NT-proBNP, cTnI, MYO, CK, CK-MB and other biochemical test,then inquiringand record the history, clinical features, major adverse cardiac events duringhospitalization,collect and analyze relevant information.Results:173patients with chest pain enrolled in the study, the patientswho eventually diagnosed as STEMI (A group,76cases), NSTEMI (group B,24cases), UA (group C,59cases), NCCP (group D,14cases).0-3hours are65cases,3-6hours are52cases,6-12hours are56cases.1The differences of A, B, C, D four groups have not statisticallysignificant in age, gender, smoking, history of hypertension, hyperlipidemia,diabetes, onset time and etc, P>0.05.2Compare with the composition of STEMI, NSTEMI, UA and NCCP indifferent times of chest pain onset, the difference has not statisticallysignificant (P>0.05).3Respectively compared the positive rate of indicators of A, B, C, D fourgroups under the condition of chest pain onset within three hours:⑴Comparewith cTnI of group A,the difference of H-FABP,cTnI+H-FABP andcTnI+MYO has statistically significant(P <0.05);⑵Compare with cTnI ofgroup B,the difference of H-FABP and cTnI+H-FABP has statisticallysignificant(P <0.05);⑶Compare with cTnI of group C and D,the difference ofall indicators has not statistically significant(P>0.05).⑷Compared the cTnI combined with H-FABP or MYO to cTnI alone,the difference has statisticallysignificant(P<0.05).⑸The accuracy of cTnI (52.3%) is significantly lowerthan H-FABP (72.3%), and the accuracy of cTnI+H-FABP (66.2%) andcTnI+MYO（56.9%）are both significantly higher than cTnI.⑹Youden ofcTnI (0.099) is lower than H-FABP (0.467), cTnI+H-FABP (0.325)andcTnI+MYO (0.140).4Respectively compared the positive rate of indicators of A, B, C, D fourgroups under the condition of chest pain onset within3-6hours:⑴Comparewith cTnI of group A, the difference of cTnI+H-FABP and cTnI+MYO hasstatistically significant(P<0.05);⑵Compare with cTnI of group C, thedifference of cTnI+MYO has statistically significant(P<0.05);⑶Comparewith cTnI of group B and D, the difference of all indicators has notstatistically significant(P>0.05).⑷Compared the cTnI+H-FABP to cTnIalone,the difference has statistically significant(P<0.05).⑸The accuracy ofcTnI (84.6%) is significantly lower than H-FABP (88.5%) and cTnI+H-FABP(86.5%),the accuracy of cTnI+MYO（80.8%）is lower than cTnI.⑹Youden of cTnI (0.694) is lower than H-FABP (0.738), Youden of cTnI+H-FABP and cTnI+MYO are0.650,0.519.5Respectively compared the positive rate of indicators of A, B, C, D fourgroups under the condition of chest pain onset within6-12hours:⑴Comparewith cTnI of group A,B,C and D,the difference of all indicators has notstatistically significant(P>0.05).⑵The accuracy of cTnI (94.6%) is lowerthan H-FABP (96.4%),the accuracy of cTnI+H-FABP (89.3%) andcTnI+MYO（85.7%）is lower than cTnI.⑶Youden of cTnI (0.875) islower than H-FABP (0.927), Youden of cTnI+H-FABP and cTnI+MYO are0.750,0.667.6The specificity of H-FABP in3hours,3-6hours, and6-12hours are82.8%，80.0%，95.8%; cTnI under the same condition are79.3%，85.0%，87.5%; MYO are69.0%，65.0%，75.0%;cTnI+H-FABP are69.0%，65.0%，75.0%; cTnI+MYO are58.6%,55.0%,66.7%. The specificity of H- FABP and H-FABP+cTnI are equivalent to cTnI (P>0.05)and significantlyhigher than cTnI+MYO(P＜0.05).7The negative predictive value(NPV) of H-FABP in3hours,3-6hours,and6-12hours are64.9%，88.9%，95.8%; cTnI under the same conditionare47.9%，77.3%，87.5%; MYO are47.6%，76.5%，75.0%;cTnI+H-FABP are60.6%，100%，100%; cTnI+MYO are51.5%，91.7%，100%.The NPV of H-FABP and H-FABP+cTnI are significantly higher than cTnIin0-3hours and6-12hours (P>0.05).8The Correlation analysis (Pearson Correlation) between NT-proBNPand H-FABP of chest pain onset within12hours has statisticallysignificant(R=0.724, P＜0.05).9Respectively compared the incidence of major adverse cardiac events(MACE) in group A,B,C and D in a week,it has statistically significant(P<0.05).The OR of H-FABP in A,B,C and totle is0.797,0.905,0.900and0.832，95%CI of each group is (0.704-0.902)，(0.788-1.039)，(0.732-1.107)，and(0.760-0.910)。The OR of NT-proBNP in A,B,C and totle is0.690、0.846、0.667and0.724，95%CI of each group is(0.564-0.845)，(0.671-1.007)，(0.300-1.484)，and (0.618-0.849)。Conclusion:1H-FABP has a high degree of sensitivity, specificity, and negativepredictive value, it significantly higher than cTnI, MYO, CK, CK-MB andNT-proBNP,particularly within3hours，it can be used as an indicators forearly AMI.2cTnI combines with H-FABP can significantly increase the sensitivityof diagnosis of cTnI within3hours, and it has a high specificity, comparedwith cTnI alone, it obviously improved the diagnosis of AMI within3hours.3cTnI joint H-FABP substantially enhance the NPV of cTnI within6hours. This strategy is interesting, as it may find out a potential pathway torule out AMI with a single blood draw at presentation.4H-FABP is associated with the incidence of major adverse cardiacevents.