This Article Full Text Full Text (PDF) All Versions of this Article: 114/6/550    most recent CIRCULATIONAHA.106.641936v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by O’Donoghue, M. Articles by Sabatine, M. S. Search for Related Content PubMed PubMed Citation Articles by O’Donoghue, M. Articles by Sabatine, M. S. Related Collections Acute coronary syndromes

(Circulation. 2006;114:550-557.)
© 2006 American Heart Association, Inc.

Coronary Heart Disease

Prognostic Utility of Heart-Type Fatty Acid Binding Protein in Patients With Acute Coronary Syndromes

Michelle O’Donoghue, MD; James A. de Lemos, MD; David A. Morrow, MD, MPH; Sabina A. Murphy, MPH; Jacqueline L. Buros, AB; Christopher P. Cannon, MD; Marc S. Sabatine, MD, MPH

From the TIMI Study Group (M.O., D.A.M., S.A.M., J.L.B., C.P.C., M.S.S.), Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass, and Division of Cardiology (J.A.d.L.), Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.

Correspondence to Marc S. Sabatine, MD, MPH, Brigham and Women’s Hospital, TIMI Study Group, 350 Longwood Ave, First Floor, Boston, MA 02115. E-mail msabatine{at}partners.org

Received April 26, 2006; revision received May 30, 2006; accepted June 8, 2006.

Background— Heart-type fatty acid binding protein (H-FABP) is a cytosolic protein that is released rapidly from the cardiomyocyte in response to myocardial injury. Although it has been investigated as an early marker of acute myocardial infarction, its prognostic utility in acute coronary syndromes has not been established.

Methods and Results— We measured H-FABP in 2287 patients with acute coronary syndromes from the OPUS-TIMI 16 trial. H-FABP was elevated (>8 ng/mL) in 332 patients (14.5%). Patients with an elevated H-FABP were more likely to suffer death (hazard ratio [HR], 4.1; 95% CI, 2.6 to 6.5), recurrent myocardial infarction (HR, 1.6; 95% CI, 1.0 to 2.5), congestive heart failure (HR, 4.5; 95% CI, 2.6 to 7.8), or the composite of these end points (HR, 2.6; 95% CI, 1.9 to 3.5) through the 10-month follow-up period. H-FABP predicted the risk of the composite end point both in patients who were troponin I negative (HR, 2.1; 95% CI, 1.3 to 3.4) and in those who were troponin I positive (HR, 3.3; 95% CI, 2.0 to 5.3). In a Cox proportional-hazards model that adjusted for baseline variables, including demographics, clinical characteristics, creatinine clearance, ST deviation, index diagnosis, and troponin I, elevated H-FABP remained a significant predictor of the composite end point (HR, 1.9; 95% CI, 1.3 to 2.7), as well as the individual end points of death (HR, 2.7; 95% CI, 1.5 to 4.9) and CHF (HR, 2.4; 95% CI, 1.2 to 5.0). In a multimarker approach, H-FABP, troponin I, and B-type natriuretic peptide provided complementary information.

Conclusions— Elevation of H-FABP is associated with an increased risk of death and major cardiac events in patients presenting across the spectrum of acute coronary syndromes and is independent of other established clinical risk predictors and biomarkers.

---

 

CLINICAL PERSPECTIVE

This article has been cited by other articles:

				S. E. Orfanos and S. Zakynthinos Heart biomarkers as prognostic tools for chronic thromboembolic pulmonary hypertension: a step forward by the fatty acid-binding protein Eur. Respir. J., May 1, 2008; 31(5): 915 - 917. [Full Text] [PDF]

				N. R. Sodha, R. T. Clements, J. Feng, Y. Liu, C. Bianchi, E. M. Horvath, C. Szabo, and F. W. Sellke The effects of therapeutic sulfide on myocardial apoptosis in response to ischemia-reperfusion injury Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 906 - 913. [Abstract] [Full Text] [PDF]

				M. S. Sabatine, D. A. Morrow, L. J. Higgins, C. MacGillivray, W. Guo, C. Bode, N. Rifai, C. P. Cannon, R. E. Gerszten, and R. T. Lee Complementary Roles for Biomarkers of Biomechanical Strain ST2 and N-Terminal Prohormone B-Type Natriuretic Peptide in Patients With ST-Elevation Myocardial Infarction Circulation, April 15, 2008; 117(15): 1936 - 1944. [Abstract] [Full Text] [PDF]

				J. A. de Lemos and M. O'Donoghue The Skinny on Fatty Acid-Binding Protein J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2068 - 2070. [Full Text] [PDF]

				N. Kilcullen, K. Viswanathan, R. Das, C. Morrell, A. Farrin, J. H. Barth, A. S. Hall, and for the EMMACE-2 Investigators Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Troponin Values J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2061 - 2067. [Abstract] [Full Text] [PDF]

				R. P. Giugliano and E. Braunwald The Year in Non ST-Segment Elevation Acute Coronary Syndrome J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1386 - 1395. [Full Text] [PDF]

				J. Sanz, P. R. Moreno, and V. Fuster The Year in Atherothrombosis J. Am. Coll. Cardiol., April 24, 2007; 49(16): 1740 - 1749. [Full Text] [PDF]