22 Comparison of 4-h heart fatty acid binding protein with 12-h troponin I to assess 6-month risk following percutaneous coronary intervention in acute coronary syndromes

Abstract

<h3>Background</h3> It is known that PCI can cause myocardial injury leading to the release of cardiac biomarkers into the circulation (procedural MI). This occurs in approximately one third of procedures and has been shown to impact negatively on prognosis. Monitoring for procedural MI, although not yet standard practice, is increasingly undertaken as a measure of quality control, and may be a factor when deciding time of discharge from hospital following the procedure. The use of TnI to screen for procedural MI requires a wait of 12-h post procedure before the blood sample may be taken, and an impact on length of hospital stay is inevitable. Heart-type Fatty Acid Binding Protein (H-FABP) is a small protein released rapidly and in large quantities from the myocardium into the circulation, both during ischaemia and following necrosis. It allows detection of myocardial injury associated with PCI earlier than with TnI. <h3>Hypothesis</h3> H-FABP at 4 h provides equivalent prognostic information to TnI at 12 h following PCI-induced myocardial injury. <h3>Methods</h3> We studied 94 patients with ACS admitted to a single UK Teaching Hospital for PCI. We used the Randox Cardiac-Array to measure H-FABP at 4 hrs after PCI and troponin I at 12 h after PCI. Comparison of specificity and sensitivity of each biomarker for adverse cardiac events was made. Endpoint assessment consisted of one of the following three events (i) PC-induced MI (ii) readmission with MI by 6 months (iii) death by 6 months. <h3>Results</h3> The area under the receiver operator curve was 0.73 for H-FABP measured at 4 h as compared to 0.72 for TnI measured as 12 h. <h3>Conclusion</h3> Early assessment of PCI-induced myocardial injury using the Randox Cardiac-Array to measure H-FABP is as sensitive and specific for adverse prognosis as is TnI measurement taken at 12 h post PCI. This approach should help to expedite early, safe hospital discharge following PCI.