The value of point-of-care fatty acid binding protein in patients with chest pain in determining myocardial infarction in the emergency setting

WOS: 000279973600004Introduction: Detecting patients in the early hours of acute myocardial infarction is still a challenge for emergency physicians. Fatty acid binding protein (FABP) was thought to be released into the intravascular space earlier than cardiac troponins. The aim of this study was to determine the diagnostic value of point-of-care FABP test either in diagnosing or excluding myocardial infarction during the initial admission of patients presenting with typical chest pain to the emergency department. Methods: This study was performed in a tertiary care emergency department. Patients with typical chest pain were included into the study. Point-of-care FABP was studied during the initial admission and two hours after admission. Patients were diagnosed as myocardial infarction or not ultimately by ECG and troponin levels. Results: A total of 224 patients were included into the study, 73 of them (32.6%) were diagnosed as acute myocardial infarction. FABP had a sensitivity and specificity of 41.0% (95%CI 29.7 to 53.2) and 100% (95%CI 97.6 to 100) and myoglobin had a sensitivity and specificity of 57.5% (95%CI 45.4 to 69.0) and 90.7% (95%CI 85.0 to 95.0) during the initial admission. Cardiac troponin T had a sensitivity of 45.2% (95%CI 33.7 to 57.2) and specificity of 100% (95%CI 97.0 to 100) during the initial admission. Two hours after admission, FABP had a sensitivity of 56.0% (95%CI 40.0 to 71.0) and specificity of 99.0% (95%CI 96.4 to 100) respectively. Conclusions: Point-of-care FABP is good at diagnosing acute myocardial infarction in patients presenting with chest pain. However, FABP was found to be not better than either myoglobin or cardiac troponin T in excluding acute myocardial infarction in patients presenting with chest pain. (Hong Kong j.emerg.med. 2010;17:224-229