PMID- 28566132 OWN - NLM STAT- MEDLINE DCOM- 20180727 LR - 20180727 IS - 1444-2892 (Electronic) IS - 1443-9506 (Linking) VI - 27 IP - 4 DP - 2018 Apr TI - Early Diagnostic Performance of Heart-Type Fatty Acid Binding Protein in Suspected Acute Myocardial Infarction: Evidence From a Meta-Analysis of Contemporary Studies. PG - 503-512 LID - S1443-9506(17)30336-0 [pii] LID - 10.1016/j.hlc.2017.03.165 [doi] AB - BACKGROUND: Although cardiac troponin is the cornerstone in diagnosis of acute myocardial infarction (AMI), the accuracy is still suboptimal in the early hours after chest pain onset. Due to its small size, heart-type fatty acid-binding protein (H-FABP) has been reported accurate in diagnosis of AMI, however, this remains undetermined. The aim is to investigate the diagnostic performance of H-FABP alone and in conjunction with high-sensitivity troponin (hs-Tn) within 6 hours of symptom onset. Furthermore, accuracy in 0h/3h algorithm was also assessed. METHODS: Medline and EMBASE databases were searched; sensitivity, specificity and area under ROC curve (AUC) were used as measures of the diagnostic accuracy. We pooled data on bivariate modelling, threshold effect and publication bias was applied for heterogeneity analysis. RESULTS: Twenty-two studies with 6602 populations were included, pooled sensitivity, specificity and AUC of H-FABP were 0.75 (0.68-0.81), 0.81 (0.75-0.86) and 0.85 (0.82-0.88) within 6 hours. Similar sensitivity (0.76, 0.69-0.82), specificity (0.80, 0.71-0.87) and AUC (0.85, 0.82-0.88) of H-FABP were observed in 4185 (63%) patients in 0h/3h algorithm. The additional use of H-FABP improved the sensitivity of hs-Tn alone but worsened its specificity (all p<0.001), and resulted in no improvement of AUC (p>0.99). There was no threshold effect (p=0.18) and publication bias (p=0.31) in this study. CONCLUSIONS: H-FABP has modest accuracy for early diagnosis of AMI within 3 and 6 hours of symptom onset. The incremental value of H-FABP seemed much smaller and was of uncertain clinical significance in addition to hs-Tn in patients with suspected AMI. Routine use of H-FABP in early presentation does not seem warranted. CI - Copyright (c) 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved. FAU - Xu, Li-Qian AU - Xu LQ AD - Department of Geriatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China. FAU - Yang, Yun-Mei AU - Yang YM AD - Department of Geriatrics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China. FAU - Tong, Hong AU - Tong H AD - Department of Cardiology, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China. FAU - Xu, Chang-Fu AU - Xu CF AD - Department of Cardiology, Tongde Hospital of Zhejiang Province, Hangzhou, 310012, China. Electronic address: changfu_xu@126.com. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review DEP - 20170504 PL - Australia TA - Heart Lung Circ JT - Heart, lung & circulation JID - 100963739 RN - 0 (Biomarkers) RN - 0 (Fatty Acid Binding Protein 3) SB - IM MH - Biomarkers/blood MH - *Early Diagnosis MH - Fatty Acid Binding Protein 3/*blood MH - Humans MH - Myocardial Infarction/*blood/*diagnosis MH - ROC Curve MH - Reproducibility of Results OTO - NOTNLM OT - Acute myocardial infarction OT - Early diagnosis OT - Heart-type fatty acid binding protein OT - Meta-analysis EDAT- 2017/06/02 06:00 MHDA- 2018/07/28 06:00 CRDT- 2017/06/02 06:00 PHST- 2016/09/19 00:00 [received] PHST- 2017/01/11 00:00 [revised] PHST- 2017/03/29 00:00 [accepted] PHST- 2017/06/02 06:00 [pubmed] PHST- 2018/07/28 06:00 [medline] PHST- 2017/06/02 06:00 [entrez] AID - S1443-9506(17)30336-0 [pii] AID - 10.1016/j.hlc.2017.03.165 [doi] PST - ppublish SO - Heart Lung Circ. 2018 Apr;27(4):503-512. doi: 10.1016/j.hlc.2017.03.165. Epub 2017 May 4.