Early markers of myocardial injury: cTnI is enough

Clin Chim Acta. 2009 Feb;400(1-2):82-5. doi: 10.1016/j.cca.2008.10.005. Epub 2008 Nov 1.


Background: We compared the early diagnostic and prognostic performance of a highly sensitive cardiac troponin I (cTnI) assay with heart-type fatty acid binding protein (H-FABP), in the early hours of acute coronary syndrome.

Methods: Serum samples of 293 patients were studied using the Abbott Architect cTnI assay and the H-FABP assay. Special attention was paid to the diagnostic and prognostic value of admission blood samples taken <24 h after symptom onset. The prognostic endpoint was total mortality and reinfarction at 6 months.

Results: To detect forthcoming myocardial injury, admission samples gave receiver operating curve (ROC) areas (AUC) of 0.908 for cTnI and 0.855 for H-FABP (p=0.068) when the delay from symptom onset was <6 h (60.4% of all patients). When the delay was 6-24 h, the corresponding AUC values were 0.995 for cTnI and 0.849 for H-FABP (p=0.002). In multivariate analysis cTnI but not H-FABP predicted adverse events in all 293 patients (RR 3.02, 95% CI 1.62-5.63) and in those with delays <6 h (RR 2.92, 95% CI 1.47-5.81).

Conclusion: In the era of highly sensitive cTnI assays, H-FABP appears to give no additional information even in patients who present within the first 6 h after acute MI.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / blood*
  • Acute Coronary Syndrome / diagnosis*
  • Aged
  • Biomarkers / blood
  • Fatty Acid Binding Protein 3
  • Fatty Acid-Binding Proteins / blood
  • Female
  • Humans
  • Male
  • Multivariate Analysis
  • Myocardium / metabolism*
  • Patient Admission
  • Prognosis
  • Sensitivity and Specificity
  • Time Factors
  • Troponin I / blood*


  • Biomarkers
  • FABP3 protein, human
  • Fatty Acid Binding Protein 3
  • Fatty Acid-Binding Proteins
  • Troponin I