| Background: Acute coronary syndrome (ACS) is identified as a group of acute ischemic syndrome resulting from the disruption of the atherosclerotic plaque and subsequently the formation of thrombosis. ACS includes ST elevated myocardial infarction (STEMI), non ST elevated myocardial infarction (NSTEMI) and unstable angina pectoris (UA). STEMI, NSTEMI and UA are different in their therapy and prognosis. Treatment of NSTEMI and UA involved antiplatelet and anticoagulant therapy, whereas the most key treatment for STEMI are early reperfusion by either thrombolysis or PCI. Thus, it is important to make a type-specific diagnose of ACS in the early stage. The most updated recommendations for AMI diagnosis suggested that biomarkers of myocardial infarction are the bases of the diagnosis and other information such as history, electrocardiogram, and coronary angiography should also be taken into account. Cardiac troponin I (cTnI) is a specific marker for myocardial infarction and is now widely used in clinical practice, however its elevation can be tested in blood only after 6 hours of AMI. On the contrary, myoglobin has an earlier increase compared to cTnI but with a low specificity for myocardial infarction. So a quick-responsive and high specific biomarker for AMI is needed to make an early definite diagnosis of STEMI and NSTEMI. H-FABP is a low molecular weight plasmosin with a high degree of specificity, and it has been reported that the H-FABP can be used to diagnose AMI in early stage. Because the quantitative assay of H-FABP is time consuming, the qualitative assay is preferred in emergency clinic.Object: To test if the qualitative assay of H-FABP can be used for the diagnosis of acute myocardial infarction in the early stage. Moreover, to compare the diagnostic efficacy of cTnI and H-FABP in differentiating diagnosis of ACS.Methods: Fifty one patients with ACS including 23 AMI and 28 UA were selected in this study. Venous blood samples were taken twice at time points of within-6 hours and beyond-6 hours of chest pain onset. According to solid phase immuno -chromatographic theory, we tested the H—FABP by using quick reactant board. CK-MB and cTnI were quantitatively measured at the same time.Result: There is no significant difference in positive rate of H—FABP(0% vs 0%) and cTnI (0.30±0.19 vs. 0.44±0.20) between within-6 hours and beyond-6 hours time point in UA groups .No significant difference in positive rate of H—FABP(96% vs. 100%) between within-6 and beyond-6 hours time point in AMI groups, but the cTnI of beyond-6 hours point (3.87±1.97) was significantly higher than that of within-6 hours point (1.31±1. 20, P<0. 05) in AMI patients. The sensitivity (95.65 %), accuracy (98.40%) and the negative predictive value (96.55%) of FABP were superior to cTnI (47.83%, 76.47%, 70.00%) (P<0.05) within 6 hours of the chest pain onset. But the differences of these parameters between FABP and cTnI disappeared after 6 hours of chest pain onset. In terms of diagnositic efficacy, H—FABP is superior to cTnI within 6 hours of symptom onset (P< 0.005), while no difference was found after 6 hours of symptom onset(P > 0.5).Conclusion: As a new myocardiolysis marker, H—FABP has a high sensitivity, specificity, positive and negative predictive value. Within 6 hours of onset of AMI, the H-FABP has a better diagnostic efficacy than cTnI. The H—FABP can be used in the early diagnosis of AMI. However, it is unclear whether the H—FABP has a diagnostic value in patients with UA. Further study is needed for its role in evaluating the prognosis of UA. |
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