Early markers of myocardial injury: cTnI is enough

• Published in: Clinica chimica acta Vol. 400; no. 1; pp. 82 - 85
• Main Authors: Ilva, Tuomo, Lund, Juha, Porela, Pekka, Mustonen, Harri, Voipio-Pulkki, Liisa-Maria, Eriksson, Susann, Pettersson, Kim, Tanner, Pirjo, Pulkki, Kari
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2009
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Aged; Biomarkers - blood; Diagnosis; Fatty Acid Binding Protein 3; Fatty Acid-Binding Proteins - blood; Female; H-FABP; Humans; Male; Multivariate Analysis; Myocardial infarction; Myocardium - metabolism; Patient Admission; Prognosis; Sensitivity and Specificity; Time Factors; Troponin; Troponin I - blood; Myocardial infarction; H-FABP; Troponin; Prognosis; Diagnosis
• ISSN: 0009-8981; 1873-3492
• DOI: 10.1016/j.cca.2008.10.005

We compared the early diagnostic and prognostic performance of a highly sensitive cardiac troponin I (cTnI) assay with heart-type fatty acid binding protein (H-FABP), in the early hours of acute coronary syndrome. Serum samples of 293 patients were studied using the Abbott Architect cTnI assay and the H-FABP assay. Special attention was paid to the diagnostic and prognostic value of admission blood samples taken < 24 h after symptom onset. The prognostic endpoint was total mortality and reinfarction at 6 months. To detect forthcoming myocardial injury, admission samples gave receiver operating curve (ROC) areas (AUC) of 0.908 for cTnI and 0.855 for H-FABP ( p = 0.068) when the delay from symptom onset was < 6 h (60.4% of all patients). When the delay was 6–24 h, the corresponding AUC values were 0.995 for cTnI and 0.849 for H-FABP ( p = 0.002). In multivariate analysis cTnI but not H-FABP predicted adverse events in all 293 patients (RR 3.02, 95% CI 1.62–5.63) and in those with delays < 6 h (RR 2.92, 95% CI 1.47–5.81). In the era of highly sensitive cTnI assays, H-FABP appears to give no additional information even in patients who present within the first 6 h after acute MI.