BACKGROUND: The whole blood rapid troponin T test, used to determine the early diagnosis of acute myocardial infarction (AMI), is effective only for 3-4 h after onset. METHODS AND RESULTS: The present office cardiologists cooperative study compared the diagnostic efficacy of a newly developed whole blood rapid panel test for heart-type fatty acid-binding protein (H-FABP) with that of the rapid troponin T test in 129 consecutive patients with suspicious AMI according to certain time-frames from onset to presentation. Thirty-one patients (24.0%) had a final diagnosis of AMI. The respective sensitivities of the rapid H-FABP and troponin T tests were 100% vs 50% (p<0.05) for patients presenting within 3 h of onset; 75% vs 0% for those between 3 and 6 h; 100% vs 60% for those between 6 and 12 h; and 100% vs 100% for those presenting later than 12 h. The respective specificities were 63% vs 96.3% (p<0.05); 93.8% vs 93.8%; 72.7% vs 100%; and 75.0% vs 87.5%. Negative predictive value was 100% vs 86.7%; 93.8% vs 78.9%; 100% vs 84.6%; and 100% vs 100%, respectively. Patients with non-AMI myocardial damage associated with unstable angina or severe heart failure showed positive H-FABP test results and blunted the specificity. CONCLUSIONS: When using the novel rapid H-FABP test, cardiac emergency triage to exclude non-AMI patients should be effectively organized within 3 h of onset.
BACKGROUND: The whole blood rapid troponin T test, used to determine the early diagnosis of acute myocardial infarction (AMI), is effective only for 3-4 h after onset. METHODS AND RESULTS: The present office cardiologists cooperative study compared the diagnostic efficacy of a newly developed whole blood rapid panel test for heart-type fatty acid-binding protein (H-FABP) with that of the rapid troponin T test in 129 consecutive patients with suspicious AMI according to certain time-frames from onset to presentation. Thirty-one patients (24.0%) had a final diagnosis of AMI. The respective sensitivities of the rapid H-FABP and troponin T tests were 100% vs 50% (p<0.05) for patients presenting within 3 h of onset; 75% vs 0% for those between 3 and 6 h; 100% vs 60% for those between 6 and 12 h; and 100% vs 100% for those presenting later than 12 h. The respective specificities were 63% vs 96.3% (p<0.05); 93.8% vs 93.8%; 72.7% vs 100%; and 75.0% vs 87.5%. Negative predictive value was 100% vs 86.7%; 93.8% vs 78.9%; 100% vs 84.6%; and 100% vs 100%, respectively. Patients with non-AMI myocardial damage associated with unstable angina or severe heart failure showed positive H-FABP test results and blunted the specificity. CONCLUSIONS: When using the novel rapid H-FABP test, cardiac emergency triage to exclude non-AMI patients should be effectively organized within 3 h of onset.
Authors: Harsh Goel; Joshua Melot; Matthew D Krinock; Ashish Kumar; Sunil K Nadar; Gregory Y H Lip Journal: Ann Med Date: 2020-08-04 Impact factor: 4.709