Comparison between Certain Parameters for Diagnosis of Acute Myocardial Infarction

Section: Original Articles
Issue
Vol. 2 No. 2 (2014): Volume 2 Issue 2
Published
Nov 2, 2014
Pages
91-98

Abstract

Background and Objective: The identification and diagnosis of acute myocardial infarction (AMI) inpatients presented with chest pain pose significant challenges, as the rate of missed AMI cases amongpatients who present to the emergency department remain inappropriately high. The aim of this work wasto study the performance of three cardiac biomarkers, these are heart-type fatty acid binding protein (HFABP),troponin I (3rd generation TOSOH AIA pack-assay) and myoglobin, for early identification ofacute myocardial infarction.Material and Methods: This study was designed as a case control study. Participants were divided intotwo groups, the first one included 82 patients diagnosed to have AMI and the second group included 50apparently healthy control subjects. Troponin I and myoglobin were measured by AIA-Pack assays fromTOSOH bioscience while H-FABP was measured by ELISA technique.Results: The area under the curve (AUC) for troponin I was the highest between the tested biomarkers(0.972 0.012) compared with H-FABP and myoglobin which were found to be (0.968 0.013) and(0.9210.022) respectively. Furthermore, by using the optimal cut-off values of the tested biomarkers, thesensitivity of H-FABP was the highest for those patients presented within the first six hours of the onsetof chest pain (90.6%), followed by troponion I and myoglobin (81.3% and 78.1% respectively). From theother hand, the sensitivity of troponin I was the highest (98%) for those patients presented after the sixthhour up to 12 hours from the onset of chest pain compared by H-FABP and myoglobin (90% and 78%respectively).Conclusion: The present study demonstrates that both improved sensitivity troponin I assay and H-FABPcan provide valuable information for the diagnosis of AMI. However, for those patients who presentedwithin the first 6 hours of the onset of chest pain, H-FABP will provide superior sensitivity, as applicationof an early biomarker potentially reduces diagnostic uncertainty for patients with suspected AMI thatallow an earlier initiation of treatment, while for those patients who presented later after the 6th hour up to12 hours of the onset of chest pain, it is more appropriate to use troponin I assay as it provide highersensitivity.Key words: Acute Myocardial Infarction, Heart-type fatty acid binding protein, Myoglobin &Troponin I.

References

  1. Achar S.; Kundu S.; Norcross W. (2005, July). Diagnosis of acute coronary syndrome. Am Fam Physician. 72. P.p 119-126.
  2. Al-Mukhtar S.; Ahmad A. (2011). Comparison between quantitative and qualitative biochemical markers in the diagnosis of acute coronary syndrome. Irq J Pharm. 11(2). P.p 101-109.
  3. Alansari S.; Croal B. (2004, September). Diagnostic value of heart fatty acid binding protein and myoglobin in patients admitted with chest pain. Ann Clin Biochem. 41. P.p 391-396.
  4. Alhadi H.; Fox K. (2004, April). Do we need additional markers of myocyte necrosis: the potential value of heart fatty acid binding protein. Q J Med. 97. P.p187-198.
  5. Alhakim D, Al-Quobaili F, Shahin E (2012). Comparison of serum H-FABP, cTnI and CK-MB levels in myocardial infarction. Retrieved from: http://scla.org.sy/magazine/issues/6_4/423.html on November 2013.
  6. Alhashemi J (2006, March). Diagnostic accuracy of a bedside qualitative immunochromatographic test for acute myocardial infarction. Am J Emerg Med. 24. P.p 149-155.
  7. Cavus U.; Coskun F.; Yavus B.; et al. (2006, July). Heart type fatty acid binding protein can be a diagnostic marker in acute coronary syndrome. J Natl Med. 98(7). P1067.
  8. Chan D.; Ng L. (2010, June) Biomarkers in acute myocardial infarction. BMC Med. 8. P.p. 34-45.
  9. Das M (2012). Biomarkers in acute coronary syndrome, heart failure and acute kidney injury. Satellites. 22. P.p.1-6.
  10. Eggers K. (2007). Cardiac troponins in patients with suspected or confirmed acute coronary syndrome. Ph.D. thesis, Faculty of Medicine, Uppsala University, Sweden.
  11. Erhardt L.; Herlitz J.; Bossaert L.; et al. (2002 August). Task force on the management of chest pain. Eur Heart J. 23. P.p.1153-1176.
  12. Franzini M.; Prontera C.; Masotti S.; et al. (2013, February). Evaluation of analytical performance of a novel immunoenzymometric assay for cTnI. Clin Chim Acta. 416. P.p. 48-49/Abstract.
  13. Ghani F.; Wu A.; Graff L.; et al. (2000, May). Role of heart- type fatty acid binding protein in early detection of acute myocardial infarction. Clin Chem. 46 (4). P.p.718-719.
  14. Jaffe A.; Ravkilde J.; Roberts R.; et al. (2000, September). It's time for a change to a troponin standard. Circulation. 102. P.p. 1216-1220.
  15. Keller T.; Zeller T.; Peelz D.; et al. (2009, August). Sensitive Troponin I Assay in Early Diagnosis of Acute Myocardial Infarction. N Engl J Med. 361. P.p. 868-877.
  16. Kumar A.; Cannon C. (2009, October). Acute coronary syndrome: diagnosis and management, part I. Mayo Clin Proc. 84(10). P.p. 917-938.
  17. Li C.; Li J.; Liang X.; et al. (2010, March). Point of care test of heart type fatty acid binding protein for the diagnosis of early acute myocardial infarction. Acta Pharmacol Sin. 31. P.p. 307-312.
  18. Lin S.; Yokoyama H.; Rac V.; et al. (2012, June). Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systemic review. Resuscitation. 83. P.p. 684-691.
  19. Mad P.; Domanovits H.; Fazelnia C.; et al. (2007, March). Human heart -type fatty binding protein as a point of care test in the early diagnosis of acute myocardial infarction. Q J Med. 100. P.p. 203-210.
  20. Melanson S.; Tanasijevic M.; Jarolim P. (2007, October). Cardiac troponin assays: a view from the clinical chemistry laboratory. Circulation. 116. P.p. e501-e504.
  21. Nakata T.; Hashimoto A.; Hase M.; et al. (2003). Human heart-type fatty acid-binding protein as an early diagnostic and prognostic marker in acute coronary syndrome. Cardiology. 99. P.p. 96104/Abstract.
  22. Owens P.; Barrett M.; Gibson T.; et al. (2010, August). Emergency department care in the United States: a profile of national data sources. Ann Emerg Med. 56. P.p.150-165.
  23. Pagani F.; Stefini F.; Gianmatteom.; et al. (2004, September). Multicenter evaluation of the TOSOH AIA-pack second generation cardiac troponin I assay. Clin Chem. 50 (9). P.p. 1707-1709.
  24. Pasaoglu H.; Ofluoglu E.; Ilhan M.; et al. (2007). The role of Heart type fatty acid binding protein (H-FABP) in acute myocardial infarction (AMI) compared to conventional cardiac biochemical markers. Turk J Med Sci. 37(2). P.p. 61-67.
  25. Paterson D.; Herring N. (2006, April). ECG diagnosis of acute ischemia and infarction: past, present and future. Q J Med. 99. P.p 219-230.
  26. Reiter M.; Twerenbold R.; Reichlin T.; et al. (2011, June). Early diagnosis of acute myocardial infarction in the elderly using more sensitive cardiac troponin assays. Eur Heart J. 32. P.p. 1379-1389.
  27. Rosman J.; Kavala G.; Obunai K.; et al. (2009, Summer). The role of heart-type fatty acid-binding protein in the diagnosis of acute coronary syndrome. Int J Angiol. 18(2). P.p. 79-81.
  28. Seino Y.; Ogata K.; Takano T.; et al. (2003, August). Use of a whole blood rapid panel test for heart-type fatty acid-binding protein in patients with acute chest pain: comparison with rapid troponin T and myoglobin tests. Am J Med. 115 (3). P.p 185-190.
  29. Slot M.; Reitsma J.; Rutten F.; et al. (2010, December). Heart-type fatty acid-binding protein in the early diagnosis of acute myocardial infarction: a systemic review and meta-analysis. Heart. 96. P.p.1957-1963.
  30. Valle H.; Riesgo L.; Bel M.; et al. (2008, June). Clinical assessment of heart-type fatty acid binding protein in early diagnosis of acute coronary syndrome. Eur J Emerg Med.15. P.p. 140144.
  31. Zimmerman J.; Fromm R.; Meyer D.; et al. (1999, April). Diagnostic marker cooperative study for the diagnosis of myocardial infarction. Circulation. 99. P.p.1671-1677.

Authors

Muthear Nazar Dawood
Akram jarjees Ahmed

Identifiers

Download this PDF file
PDF

Statistics