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Heart-type fatty acid binding protein (H-FABP) in patients in an emergency department setting, suspected of acute coronary syndrome: optimal cut-off point, diagnostic value and future opportunities in primary care.
- Source :
-
The European journal of general practice [Eur J Gen Pract] 2015; Vol. 21 (3), pp. 156-63. Date of Electronic Publication: 2015 Mar 09. - Publication Year :
- 2015
-
Abstract
- Background: Most patients presenting chest complaints in primary care are referred to secondary care facilities, whereas only a few are diagnosed with acute coronary syndrome (ACS).<br />Objective: The aim is to determine the optimal cut-off value for a point-of-care heart-type fatty acid binding protein (H-FABP) test in patients presenting to the emergency department and to evaluate a possible future role of H-FABP in safely ruling out ACS in primary care.<br />Methods: Serial plasma H-FABP (index test) and high sensitivity troponin T (hs-cTnT) (reference test) were determined in patients with any new-onset chest complaint. In a receiver operating characteristic (ROC) curve, the optimal cut-off value of H-FABP for ACS was determined. Predictive values of H-FABP for ACS were calculated.<br />Results: For 202 consecutive patients (prevalence ACS 59%), the ROC curve based on the results of the first H-FABP was equal to the ROC curve of hs-cTnT (AUC 0.79 versus 0.80). Using a cut-off value of 4.0 ng/ml for H-FABP, sensitivity for ACS of the H-FABP (hs-cTnT) tests was 73.9% (70.6%). Negative predictive value (NPV) of H-FABP for ACS in a population representative for primary care (incidence of ACS 22%) thus could reach 90.8%.<br />Conclusion: In patients presenting chest pain, plasma H-FABP reaches the highest diagnostic value when a cut-off value of 4 ng/ml is used. Diagnostic values of an algorithm combining point-of-care H-FABP measurement and a score of signs and symptoms should be studied in primary care, to learn if such an algorithm could safely reduce referral rate by GPs.
- Subjects :
- Adult
Aged
Aged, 80 and over
Chest Pain etiology
Cross-Sectional Studies
Emergency Service, Hospital
Fatty Acid Binding Protein 3
Female
Humans
Male
Middle Aged
Point-of-Care Systems
Predictive Value of Tests
ROC Curve
Acute Coronary Syndrome blood
Acute Coronary Syndrome diagnosis
Fatty Acid-Binding Proteins blood
Primary Health Care
Troponin T blood
Subjects
Details
- Language :
- English
- ISSN :
- 1751-1402
- Volume :
- 21
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- The European journal of general practice
- Publication Type :
- Academic Journal
- Accession number :
- 25751665
- Full Text :
- https://doi.org/10.3109/13814788.2015.1013934