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European Heart Journal Advance Access originally published online on August 5, 2008
European Heart Journal 2008 29(23):2843-2850; doi:10.1093/eurheartj/ehn363
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Novel biomarkers in early diagnosis of acute myocardial infarction compared with cardiac troponin T

Conor J. McCann1, Ben M. Glover1, Ian B.A. Menown2, Michael J. Moore1, Jane McEneny3, Colum G. Owens1, Bernie Smith1, Peter C. Sharpe2, Ian S. Young3 and Jennifer A. Adgey1,*

1 The Heart Centre, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK
2 Craigavon Cardiac Centre, Craigavon Area Hospital, Craigavon BT63 5QQ, Northern Ireland, UK
3 Nutrition and Metabolism Group, Centre for Clinical and Population Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast BT12 6BJ, Northern Ireland, UK

Received 27 March 2008; revised 10 July 2008; accepted 17 July 2008; online publish-ahead-of-print 5 August 2008.

* Corresponding author. Tel: +44 289 063 3714, Fax: +44 289 031 4169, Email: jennifer.adgey{at}belfasttrust.hscni.net

See page 2827 for the editorial comment on this article (doi:10.1093/eurheartj/ehn489)

Aims: To evaluate the role of novel biomarkers in early detection of acute myocardial infarction (MI) in patients admitted with acute chest pain.

Methods and results: A prospective study of 664 patients presenting to two coronary care units with chest pain was conducted over 3 years from 2003. Patients were assessed on admission: clinical characteristics, ECG (electrocardiogram), renal function, cardiac troponin T (cTnT), heart fatty acid binding protein (H-FABP), glycogen phosphorylase-BB, NT-pro-brain natriuretic peptide, D-dimer, hsCRP (high sensitivity C-reactive protein), myeloperoxidase, matrix metalloproteinase-9, pregnancy associated plasma protein-A, soluble CD40 ligand. A ≥12 h cTnT sample was also obtained. MI was defined as cTnT ≥ 0.03 µg/L. In patients presenting <4 h of symptom onset, sensitivity of H-FABP for MI was significantly higher than admission cTnT (73 vs. 55%; P = 0.043). Specificity of H-FABP was 71%. None of the other biomarkers challenged cTnT. Combined use of H-FABP and cTnT (either one elevated initially) significantly improved the sensitivities of H-FABP or cTnT (85%; P ≤ 0.004). This combined approach also improved the negative predictive value, negative likelihood ratio, and the risk ratio.

Conclusion: Assessment of H-FABP within the first 4 h of symptoms is superior to cTnT for detection of MI, and is a useful additional biomarker for patients with acute chest pain.

Key Words: Acute myocardial infarction • Diagnosis • Biomarkers


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