Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study
Background: Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with...
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| Veröffentlicht in: | European heart journal. Acute cardiovascular care 2016-08, Vol.5 (4), p.364-374 |
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| creator | Bank, Ingrid EM Dekker, Marieke S Hoes, Arno W Zuithoff, Nicolaas PA Verheggen, Peter WHM de Vrey, Evelyn A Wildbergh, Thierry X Timmers, Leo de Kleijn, Dominique PV Glatz, Jan FC Mosterd, Arend |
| description | Background:
Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset.
Methods and results:
Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test p |
| doi_str_mv | 10.1177/2048872615584077 |
| format | Article |
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Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset.
Methods and results:
Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test p<0.001) and increased area under the receiver operating characteristics curve (AUC; 0.82 vs. 0.84 and 0.84). This added value attenuated, however, after inclusion of hs-cTnT in the diagnostic model (AUC 0.88).
Conclusions:
In patients suspected of acute coronary syndrome presenting to the emergency department, H-FABP testing improves diagnostic accuracy in addition to clinical findings and electrocardiography. H-FABP, however, has no additional diagnostic value when hs-cTnT measurements are also available.</description><identifier>ISSN: 2048-8726</identifier><identifier>EISSN: 2048-8734</identifier><identifier>DOI: 10.1177/2048872615584077</identifier><identifier>PMID: 25906779</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - metabolism ; Aged ; Biomarkers - metabolism ; Early Diagnosis ; Emergency Service, Hospital ; Enzyme-Linked Immunosorbent Assay ; Fatty Acid Binding Protein 3 ; Fatty Acid-Binding Proteins - metabolism ; Female ; Humans ; Male ; Middle Aged ; Point-of-Care Systems ; Predictive Value of Tests ; Prospective Studies ; Sensitivity and Specificity ; Troponin T - metabolism</subject><ispartof>European heart journal. Acute cardiovascular care, 2016-08, Vol.5 (4), p.364-374</ispartof><rights>The European Society of Cardiology 2015</rights><rights>The European Society of Cardiology 2015.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c449t-4278850322c9702fbb73624d92949d72dca6d2cf1578af0d4e955558e132dac03</citedby><cites>FETCH-LOGICAL-c449t-4278850322c9702fbb73624d92949d72dca6d2cf1578af0d4e955558e132dac03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2048872615584077$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2048872615584077$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25906779$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bank, Ingrid EM</creatorcontrib><creatorcontrib>Dekker, Marieke S</creatorcontrib><creatorcontrib>Hoes, Arno W</creatorcontrib><creatorcontrib>Zuithoff, Nicolaas PA</creatorcontrib><creatorcontrib>Verheggen, Peter WHM</creatorcontrib><creatorcontrib>de Vrey, Evelyn A</creatorcontrib><creatorcontrib>Wildbergh, Thierry X</creatorcontrib><creatorcontrib>Timmers, Leo</creatorcontrib><creatorcontrib>de Kleijn, Dominique PV</creatorcontrib><creatorcontrib>Glatz, Jan FC</creatorcontrib><creatorcontrib>Mosterd, Arend</creatorcontrib><title>Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study</title><title>European heart journal. Acute cardiovascular care</title><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><description>Background:
Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset.
Methods and results:
Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test p<0.001) and increased area under the receiver operating characteristics curve (AUC; 0.82 vs. 0.84 and 0.84). This added value attenuated, however, after inclusion of hs-cTnT in the diagnostic model (AUC 0.88).
Conclusions:
In patients suspected of acute coronary syndrome presenting to the emergency department, H-FABP testing improves diagnostic accuracy in addition to clinical findings and electrocardiography. H-FABP, however, has no additional diagnostic value when hs-cTnT measurements are also available.</description><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - metabolism</subject><subject>Aged</subject><subject>Biomarkers - metabolism</subject><subject>Early Diagnosis</subject><subject>Emergency Service, Hospital</subject><subject>Enzyme-Linked Immunosorbent Assay</subject><subject>Fatty Acid Binding Protein 3</subject><subject>Fatty Acid-Binding Proteins - metabolism</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Point-of-Care Systems</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Troponin T - metabolism</subject><issn>2048-8726</issn><issn>2048-8734</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1UU1r3DAUNKWlCWnuPZV3TA9OZVm25NyW4G0CGwpJejZa6XmjYEtbSS74v_dQ7Uf3UNqHkJ7EzGgek2UfC3JdFJx_oYQJwWldVJVghPM32fnuKRe8ZG9PPa3PsssQXkkqTmomyvfZGa0aUnPenGe_nqawRRVRg1RTRFDOOyv9DGG22rsRwViILwg4ot-gVTN458YbWJnR7Glap_2nHCYE18MLSh8hzluEXsY4J1mjYW2sNnYDW-8iJsGtMzbu4Er6RPPQru6fFhAxxHADz-m75eKhzdtHuFruVRb_UknrYXZJQhs5pFsvvYrGWWh3duS-PbpvT-4fk_vPEOKk5w_Zu14OAS-P50X2fdk-397lq29f728Xq1wx1sScUS5ERUpKVcMJ7ddrXtaU6YY2rNGcaiVrTVVfVFzInmiGTZVKYFFSLRUpL7Krg24y_mNKM3ajCQqHQVp0U-gKQXhDSFGwBCUHqPIuBI99t_VmTHl0Bel2sXd_x54on47q03pEfSL8CTkB8gMgyA12r27yNk37f8HfZ8u3tw</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Bank, Ingrid EM</creator><creator>Dekker, Marieke S</creator><creator>Hoes, Arno W</creator><creator>Zuithoff, Nicolaas PA</creator><creator>Verheggen, Peter WHM</creator><creator>de Vrey, Evelyn A</creator><creator>Wildbergh, Thierry X</creator><creator>Timmers, Leo</creator><creator>de Kleijn, Dominique PV</creator><creator>Glatz, Jan FC</creator><creator>Mosterd, Arend</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20160801</creationdate><title>Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study</title><author>Bank, Ingrid EM ; Dekker, Marieke S ; Hoes, Arno W ; Zuithoff, Nicolaas PA ; Verheggen, Peter WHM ; de Vrey, Evelyn A ; Wildbergh, Thierry X ; Timmers, Leo ; de Kleijn, Dominique PV ; Glatz, Jan FC ; Mosterd, Arend</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c449t-4278850322c9702fbb73624d92949d72dca6d2cf1578af0d4e955558e132dac03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - metabolism</topic><topic>Aged</topic><topic>Biomarkers - metabolism</topic><topic>Early Diagnosis</topic><topic>Emergency Service, Hospital</topic><topic>Enzyme-Linked Immunosorbent Assay</topic><topic>Fatty Acid Binding Protein 3</topic><topic>Fatty Acid-Binding Proteins - metabolism</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Point-of-Care Systems</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Troponin T - metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bank, Ingrid EM</creatorcontrib><creatorcontrib>Dekker, Marieke S</creatorcontrib><creatorcontrib>Hoes, Arno W</creatorcontrib><creatorcontrib>Zuithoff, Nicolaas PA</creatorcontrib><creatorcontrib>Verheggen, Peter WHM</creatorcontrib><creatorcontrib>de Vrey, Evelyn A</creatorcontrib><creatorcontrib>Wildbergh, Thierry X</creatorcontrib><creatorcontrib>Timmers, Leo</creatorcontrib><creatorcontrib>de Kleijn, Dominique PV</creatorcontrib><creatorcontrib>Glatz, Jan FC</creatorcontrib><creatorcontrib>Mosterd, Arend</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal. Acute cardiovascular care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bank, Ingrid EM</au><au>Dekker, Marieke S</au><au>Hoes, Arno W</au><au>Zuithoff, Nicolaas PA</au><au>Verheggen, Peter WHM</au><au>de Vrey, Evelyn A</au><au>Wildbergh, Thierry X</au><au>Timmers, Leo</au><au>de Kleijn, Dominique PV</au><au>Glatz, Jan FC</au><au>Mosterd, Arend</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study</atitle><jtitle>European heart journal. Acute cardiovascular care</jtitle><addtitle>Eur Heart J Acute Cardiovasc Care</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>5</volume><issue>4</issue><spage>364</spage><epage>374</epage><pages>364-374</pages><issn>2048-8726</issn><eissn>2048-8734</eissn><abstract>Background:
Timely recognition of acute coronary syndrome remains a challenge as many biomarkers, including troponin, remain negative in the first hours following the onset of chest pain. We assessed the diagnostic accuracy of heart-type fatty acid binding protein (H-FABP), a cardiac biomarker with potential value immediately post symptom onset.
Methods and results:
Prospective monocentre diagnostic accuracy study of H-FABP bedside point of care (CardioDetect®) and ELISA tests in acute coronary syndrome suspected patients presenting within 24 hours of symptom onset to the emergency department, in addition to clinical findings, electrocardiography and the currently recommended biomarker high sensitivity troponin-T (hs-cTnT). The final diagnosis of acute coronary syndrome was adjudicated by two independent cardiologists, blinded to H-FABP results. Acute coronary syndrome was diagnosed in 149 (32.9%) of 453 unselected patients with suspected acute coronary syndrome (56% men, mean age 62.6 years). Negative predictive values were similar for H-FABP point of care and ELISA tests (79% vs. 78% respectively), but inferior to initial hs-cTnT (negative predictive value 86%). The addition of H-FABP point of care results to hs-cTnT increased the negative predictive value to 89%. In a multivariable logistic regression model, H-FABP point of care and ELISA tests yielded relevant diagnostic information in addition to clinical findings and ECG (likelihood ratio test p<0.001) and increased area under the receiver operating characteristics curve (AUC; 0.82 vs. 0.84 and 0.84). This added value attenuated, however, after inclusion of hs-cTnT in the diagnostic model (AUC 0.88).
Conclusions:
In patients suspected of acute coronary syndrome presenting to the emergency department, H-FABP testing improves diagnostic accuracy in addition to clinical findings and electrocardiography. H-FABP, however, has no additional diagnostic value when hs-cTnT measurements are also available.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>25906779</pmid><doi>10.1177/2048872615584077</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | European heart journal. Acute cardiovascular care, 2016-08, Vol.5 (4), p.364-374 |
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| source | SAGE Complete A-Z List; Oxford University Press Journals All Titles (1996-Current); MEDLINE |
| subjects | Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - metabolism Aged Biomarkers - metabolism Early Diagnosis Emergency Service, Hospital Enzyme-Linked Immunosorbent Assay Fatty Acid Binding Protein 3 Fatty Acid-Binding Proteins - metabolism Female Humans Male Middle Aged Point-of-Care Systems Predictive Value of Tests Prospective Studies Sensitivity and Specificity Troponin T - metabolism |
| title | Suspected acute coronary syndrome in the emergency room: Limited added value of heart type fatty acid binding protein point of care or ELISA tests: The FAME-ER (Fatty Acid binding protein in Myocardial infarction Evaluation in the Emergency Room) study |
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