- 作者：Karthik Viswanathan ; Niamh Kilcullen ; Christine Morrell ; Sue J. Thistlethwaite ; Mohan U. Sivananthan ; Tajek B. Hassan ; Julian H. Barth ; Alistair S. Hall
- 关键词：acute coronary syndrome ; heart-type fatty acid-binding protein ; mortality ; myocardial infarction ; troponin
- 刊名：Journal of the American College of Cardiology
- 出版年：2010
- 出版时间：8 June 2010
- 年：2010
- 卷：55
- 期：23
- 页码：2590-2598
- 全文大小：816 K
Objectives
The purpose of this study was to establish the prognostic value of measuring heart fatty acid-binding protein (H-FABP) in patients with suspected acute coronary syndrome (ACS) (in particular, low- to intermediate-risk patients), in addition to troponin measured with the latest third-generation troponin assay.Background
We have previously shown that H-FABP is a useful prognostic marker in patients with proven ACS.
Methods
Patients (n = 1,080) consecutively admitted to the hospital with suspected ACS were recruited over 46 weeks. Siemens Advia Ultra-TnI (Siemens Healthcare Diagnostics, Newbury, United Kingdom) and Randox Evidence H-FABP (Randox Laboratories, Ltd., Co., Antrim, United Kingdom) were analyzed on samples collected 12 to 24 h from symptom onset. After exclusion of patients with ST-segment elevation and new left bundle branch block, 955 patients were included in the analysis.
Results
The primary outcome measure of death or readmission with myocardial infarction after a minimum follow-up period of 12 months (median 18 months) occurred in 96 of 955 patients (10.1 % ). The H-FABP concentration was an independent predictor of death or myocardial infarction, after multivariate adjustment. Patients with H-FABP concentrations >6.48 bc;g/l had significantly increased risk of adverse events (adjusted hazard ratio: 2.62, 95 % confidence interval: 1.30 to 5.28, p = 0.007). Among troponin-negative patients (which constituted 79.2 % of the cohort), the aforementioned cutoff of 6.48 bc;g/l identified patients at very high risk for adverse outcomes independent of patient age and serum creatinine.
Conclusions
We have demonstrated that the prognostic value of elevated H-FABP is additive to troponin in low- and intermediate-risk patients with suspected ACS. Other studies suggest that our observations reflect the value of H-FABP as a marker of myocardial ischemia, even in the absence of frank necrosis.