Human heart-type fatty acid-binding protein (H-FABP) has a high potential as an early marker for acute myocardial infarction (AMI) being more sensitive than current routine cardiac markers. Seventy-four patients presenting to hospital with a median symptom onset of 2.2 h (IQR 1.5-2.9 h) were enrolled in this study and 54 (73%) had AMI. At presentation, H-FABP gave the highest sensitivity of 83.3% (95% CI: 70.7-92.1) and troponin I (cTnI) gave the highest specificity of 50.0% (95% CI: 27.2-72.8). This study demonstrated that H-FABP immunotest gave a better diagnostic classification at the early stage. Also, AMI was identified significantly earlier by H-FABP than cTnI (17 vs. 6 patients, p<0.05).