| Objective: Acute coronary syndrome (ACS) is a clinical severe disease,due to its clinical manifestations are diverse, considerable patients delayedtherapies because of missed diagnosis. The world health organizationestimates to2020coronary heart disease will become the first killer of humanhealth. Along with the increase of its incidence, fast and accurate diagnosisand effective treatment of ACS has become a hot spot in the study of themedical profession. Cardiac markers are an important tool in the diagnosis ofACS. At the moment “the golden standard” for the diagnosis of ACS istroponin, but it only raises several hours after myocardial infarction occurs.Frequently, its delay affects timely diagnosis and therapy. This study is toevaluate whether heart-type fatty acid binding protein (H-FABP) combinedischemia modified albumin (IMA) can efficiently help to select patients ofACS, and provide valuable informations for risk stratification of ACS.Methods: A total of160patients that arrived at hospital within12hr afterthe onset of chest pain were included,92male, and68female. All subjectswere aged from38to80years old. Pregnant women, patients aftercardio-pulmonary resuscitation, infection, cancer, renal failure, heart failure,patients with symptoms and signs suggestive of acute mesenteric ischemia,severe heart valve disease, chronic obstructive pulmonary disease, peripheralvascular disease, and brain ischemia were not enrolled in the study. Accordingto the time interval from onset of chest pain to arriving at the hospital, wedivided the patients into≤3h,3-6h, and6-12h three groups. Besides,50healthy people in the outpatient service were enrolled as normal control group.All suspected ACS patients with immediate18line electrocardiogram (ECG),and blood samples for the troponin I(cTnI)、H-FABP and IMA tests were taken at hospital presentation. cTnI was detected again when12hr after the onset ofchest pain in patients who cTnI was negative for the first time.Coronaryangiography was carried in the160patients. Two experienced docters wereresponsible for assigning a final diagnosis on the basis of patients,history,results of ECG, coronary angiography, and other examines as available, butunknown the results of H-FABP and IMA. Of the enrolled patients,134weredischarged with a final diagnosis of ACS and26with the diagnosis ofnonischemia chest pain(NICP). cTnI>0.04ng/ml, H-FABP>3.3ug/L andIMA>82.5U/ml were positive in the study. The measure data was presentedas mean±standard deviation, the counting data was presented as number(percentage). Analysis were used to check differences between groups bySPSS16.0，P<0.05was considered statistically significant.Results:1Final diagnosis1.1134patients were discharged with a final diagnosis of ACS, that is60patients were AMI,14patients were UA of low risk,28patients were UA ofmiddle risk and32patients were UA of high risk.1.226patients were discharged with a final diagnosis of NICP.2Analysis of receiver-operator characteristic curve (ROC curve)We took outpatient service medical person as "control group", patients ofACS as "disease group", and used SPSS16.0drawing the ROC curves. Theoptimum diagnostic cut-off point of IMA in the study population was found tobe82.5U/ml. IMA>82.5U/ml demonstrated a sensitivity of88.1%and aspecificity of86%for the diagnosis of ACS.The area of ROC curve was0.926(95%CI0.882-0.970).3Divided the patients according to time interval3.1At the basal levels of the three groups(≤3h,3-6h, and6-12h) interms of age, sex, smoking, hypertension, hypercholesterolemia, familyhistory of CAD, serum creatinine, body mass index, and diabetes mellitus,there is no statistical differences (P>0.05).3.2Comparisions of sensitivity 3.2.1In the group of≤3h, the sensitivities of cTnI, H-FABP, IMA,H-FABP combined IMA to diagnose ACS are6.82%,45.45%,50.00%and68.18%, respectively. The sensitivities of H-FABP, IMA and H-FABPcombined IMA are superior to cTnI (P <0.05). The sensitivity of IMA issuperior to H-FABP, but there is no statistical differences(P>0.05). Thesensitivity of H-FABP combined IMA is superior to H-FABP and IMA (P<0.05).3.2.2In the group of3-6h, the sensitivities of cTnI, H-FABP, IMA,H-FABP combined IMA to diagnose ACS are32.69%,73.08%,75.00%,90.38%, respectively. The sensitivities of H-FABP, IMA and H-FABPcombined IMA are superior to cTnI (P <0.05). The sensitivity of IMA issuperior to H-FABP, but there is no statistical differences(P>0.05). Thesensitivity of H-FABP combined IMA is superior to H-FABP and IMA (P<0.05).3.2.3In the group of6-12h, the sensitivities of cTnI, H-FABP, IMA,H-FABP combined IMA to diagnose ACS are71.05%,94.74%,39.47%,97.37%, respectively. The sensitivities of H-FABP and H-FABP combinedIMA are superior to cTnI (P <0.05). The sensitivity of H-FABP combinedIMA is superior to H-FABP, but there is no statistical differences(P>0.05).3.3Comparisions of specificity3.3.1In the group of≤6h, the specificities of cTnI, H-FABP, IMA,H-FABP combined IMA to diagnose ACS are100%,100%,92.9%,92.9%,respectively. The specificities of cTnI and H-FABP are superior to IMA andH-FABP combined IMA, but there is no statistical differences(P>0.05).3.3.2In the group of6-12h, the specificities of cTnI, H-FABP, IMA,H-FABP combined IMA to diagnose ACS are all100%, there is no statisticaldifferences(P>0.05).4Divided the patients according to risk stratification4.1At the basal levels of the six groups(normal control group, NICP, UAof low risk, UA of middle risk, UA of high risk and AMI) in terms of age, sexand serum creatinine, there was no statistical differences(P>0.05). 4.2The relationship between H-FABP(IMA) and risk stratification4.2.1The H-FABP concentrations of normal control group, NICP, UA oflow risk, UA of middle risk, UA of high risk and AMI are1.8±0.9ug/L,2.5±0.8ug/L,13.3±3.3ug/L,21.4±3.5ug/L,35.1±4.3ug/L,49.4±4.5ug/L,respectively. There is no statistical difference between normal control groupand NICP group(P>0.05)，but there is statistical difference between any othertwo groups(P <0.05).4.2.2The IMA concentrations of normal control group, NICP, UA of lowrisk, UA of middle risk, UA of high risk and AMI are61.3±13.5U/ml,64.9±9.0U/ml,86.0±4.9U/ml,92.7±4.4U/ml,98.8±5.5U/ml,109.3±5.0U/ml,respectively. There is no statistical difference between normal control groupand NICP group(P>0.05)，but there is statistical difference between any othertwo groups(P <0.05).Conclusions:1The sensitivities of H-FABP and IMA to diagnose ACS are superior tocTnI, especially in the first6hours after the onset of chest pain.2The sensitivity of H-FABP combined IMA is superior to cTnI、H-FABPand IMA, so when patients are just admitted to hospital detecting H-FABP andIMA can select the high risk patients of ACS more efficiently.3The concentrations of H-FABP and IMA that detected at hospitalpresentation are related to risk stratification of ACS.Detection theconcentrations of H-FABP and IMA when patients are just admitted tohospital can provide valuable informations for risk stratification of ACS. |
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