Ecollan Patrick, Collet Jean-Philippe, Boon Guillaume, Tanguy Marie-Laure, Fievet Marie-Laurence, Haas Rosita, Bertho Nicolas, Siami Shidash, Hubert Jean-Christophe, Coriat Pierre, Montalescot Gilles
SAMU, Pitié-Salpêtrière University Hospital, Paris, France.
Int J Cardiol. 2007 Jul 31;119(3):349-54. doi: 10.1016/j.ijcard.2006.09.003. Epub 2006 Nov 13.
To evaluate the diagnostic performance of a portable semi-quantitative whole blood immunoassay measuring soluble human fatty acid-binding protein [H-FABP] (CardioDetect) for the pre-hospital detection of myocardial infarction (MI).
We enrolled prospectively 108 consecutive patients with acute ischemic type chest pain in whom the first medical care was delivered by a mobile intensive care unit (MICU). CTnI, myoglobin, CK-MB and CardioDetect were first assessed in the MICU before hospital admission using point-of-care assays and then cTnI was serially measured during the hospital stay. MI was defined as a positive cTnI in any sample over the first 24 h. The vast majority of the patients (77/108) were admitted <3 h of symptoms onset. Pre-hospital cTnI sample was normal in 96 patients (88.9%) of whom 43 had subsequent cTnI elevation. A positive H-FABP using the CardioDetect assay had a significantly better sensitivity than cTnI, myoglobin and CK-MB (87.3% vs 21.8%, 64.2% and 41.5%, respectively) to identify MI. The significant better sensitivity of the CardioDetect assay was also observed among patients who presented <3 h of symptom onset. The specificity of the CardioDetect assay was significantly better than that of myoglobin, irrespective of the time delay from symptom onset to measurement. In patients with normal pre-hospital cTnI and no ST-elevation (n=63), assessment based only on a positive H-FABP had 83.3% sensitivity, 93.3% specificity for the diagnosis of an evolving MI.
Early assessment of H-FABP in patients presenting with chest pain improves the diagnosis of ongoing MI.
评估一种用于院前检测心肌梗死（MI）的便携式半定量全血免疫分析法检测可溶性人脂肪酸结合蛋白 [H-FABP]（CardioDetect）的诊断性能。
我们前瞻性纳入了108例连续的急性缺血性胸痛患者，他们首次接受的医疗护理由移动重症监护单元（MICU）提供。入院前在MICU使用即时检测法首次评估肌钙蛋白I（cTnI）、肌红蛋白、肌酸激酶同工酶（CK-MB）和CardioDetect，然后在住院期间连续测量cTnI。MI定义为最初24小时内任何样本中的cTnI呈阳性。绝大多数患者（77/108）在症状发作后<3小时入院。96例患者（88.9%）的院前cTnI样本正常，其中43例随后出现cTnI升高。使用CardioDetect分析法检测到的H-FABP呈阳性在识别MI方面的敏感性显著高于cTnI、肌红蛋白和CK-MB（分别为87.3%对21.8%、64.2%和41.5%）。在症状发作<3小时就诊的患者中也观察到CardioDetect分析法具有显著更高的敏感性。无论从症状发作到测量的时间延迟如何，CardioDetect分析法的特异性均显著优于肌红蛋白。在院前cTnI正常且无ST段抬高的患者（n = 63）中，仅基于H-FABP呈阳性进行评估对诊断进展性MI的敏感性为83.3%，特异性为93.3%。
对胸痛患者早期评估H-FABP可改善对正在发生的MI的诊断。
