Received on December 31, 2004
Accepted on May 3, 2005

Proteomics and Protein Markers

Prognostic Value of Serum Concentration of Heart-Type Fatty Acid-Binding Protein Relative to Cardiac Troponin T on Admission in the Early Hours of Acute Coronary Syndrome

¹ Division of Critical Care, Fujita Health University Graduate School of Health Sciences, Toyoake, Japan
² Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Japan
³ Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University Hospital, Toyoake, Japan

Background: Heart-type fatty acid-binding protein (H-FABP) is proposed as an early biomarker for acute myocardial infarction (AMI), but its prognostic value is unclear in acute coronary syndrome (ACS). We evaluated the prognostic value of the H-FABP concentration relative to cardiac troponin T (cTnT) in the early hours of ACS.

Methods: Serum concentrations of H-FABP and cTnT were measured on admission in 328 consecutive patients hospitalized for ACS within 6 h after the onset of chest pain [AMI, 241 (73.5%) patients; ST-segment elevation myocardial infarction, 154 (47.0%) patients; and emergent coronary angiography within 24 h after admission, 287 (87.5%) patients]. Cardiac events, which were defined as cardiac death or subsequent nonfatal AMI, were monitored for 6 months after admission.

Results: During the 6-month follow-up period, there were 25 cardiac events, including 15 cardiac deaths and 10 subsequent nonfatal AMIs. Stepwise multivariate analyses including clinical, electrocardiographic, and biochemical variables revealed that increased H-FABP (above the median value of 9.8 µg/L), but not increased cTnT (above the median value of 0.02 µg/L), was independently associated with cardiac events in all patients [relative risk (RR) = 9.0; P = 0.0004], the subgroup of patients with ST-segment elevation myocardial infarction (RR = 11.3; P = 0.02), and the subgroup of patients with unstable angina and non-ST-segment elevation myocardial infarction (RR = 8.3; P = 0.007). The area under the ROC curve was higher for H-FABP than for cTnT (0.711 vs 0.578; P = 0.08), suggesting that H-FABP concentrations have a greater predictive capacity for cardiac events than cTnT.

Conclusion: Serum H-FABP is a potential independent predictor of cardiac events within 6 months of patient admission and may provide prognostic information superior to cTnT in the early hours of ACS.