Background: Improved ability to rapidly rule-out Acute Myocardial Infarction (AMI) in patients presenting with\nchest pain will promote decongestion of the Emergency Department (ED) and reduce unnecessary hospital\nadmissions. We assessed a new commercial Heart Fatty Acid Binding Protein (H-FABP) assay for additional\ndiagnostic value when combined with cardiac troponin (using a high sensitivity assay).\nMethods: H-FABP and high-sensitivity troponins I (hs-cTnI) and T (hs-cTnT) were measured in samples taken\non-presentation from patients, attending the ED, with symptoms triggering investigation for possible acute coronary\nsyndrome. The optimal combination of H-FABP with each hs-cTn was defined as that which maximized the proportion\nof patients with a negative test (low-risk) whilst maintaining at least 99 % sensitivity for AMI. A negative test comprised\nboth H-FABP and hs-cTn below the chosen threshold in the absence of ischemic changes on the ECG.\nResults: One thousand seventy-nine patients were recruited including 248 with AMI. H-FABP < 4.3 ng/mL plus hs-cTnI\n< 10.0 ng/L together with a negative ECG maintained >99 % sensitivity for AMI whilst classifying 40.9 % of patients as\nlow-risk. The combination of H-FABP < 3.9 ng/mL and hs-cTnT < 7.6 ng/L with a negative ECG maintained the same\nsensitivity whilst classifying 32.1 % of patients as low risk.\nConclusions: In patients requiring rule-out of AMI, the addition of H-FABP to hs-cTn at presentation (in the absence of\nnew ischaemic ECG findings) may accelerate clinical diagnostic decision making by identifying up to 40 % of such\npatients as low-risk for AMI on the basis of blood tests performed on presentation. If implemented this has the\npotential to significantly accelerate triaging of patients for early discharge from the ED.
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