Jones Julia D, Chew Pei G, Dobson Rebecca, Wootton Andrew, Ashrafi Reza, Khand Aleem
University Hospital Aintree NHS Foundation Trust, Liverpool, United Kingdom.
RMIT University, Melbourne, Victoria, Australia.
Curr Cardiol Rev. 2017;13(3):189-198. doi: 10.2174/1573403X13666170116121451.
Heart type fatty acid protein (HFABP) is a cytosolic protein released early after acute coronary syndrome (ACS) even in the absence of myocardial necrosis.
The purpose of this systematic review was to determine whether HFABP levels in patients with suspected, or confirmed ACS, improve risk stratification when added to established means of risk assessment.
We searched Medline, Pubmed and Embase databases from inception to July 2015 to identify prospective studies with suspected or confirmed ACS, who had HFABP measured during the index admission with at least 1 month follow up data. A prognostic event was defined as allcause mortality or acute myocardial infarction (AMI).
7 trials providing data on 6935 patients fulfilled inclusion criteria. There were considerable differences between studies and this was manifest in variation in prognostic impact of elevated HFABP(Odds ratio range 1.2-15.2 for death). All studies demonstrated that HFABP provide unadjusted prognostic information and in only one study this was negated after adjusting for covariates. A combination of both negative troponin and normal HFABP conferred a very low event rate. No study evaluated the incremental value of HFABP beyond that of standard risk scores. Only one study used a high sensitive troponin assay.
There was marked heterogeneity in prognostic impact of HFABP in ACS between studies reflecting differences in sampling times and population risk. Prospective studies of suspected ACS with early sampling of HFABP in the era of high sensitivity troponin are necessary to determine the clinical value of HFABP. HFABP should not currently be used clinically as a prognostic marker in patients with suspected ACS.
心脏型脂肪酸结合蛋白（HFABP）是一种胞质蛋白，即使在无心肌坏死的情况下，急性冠状动脉综合征（ACS）发生后也会早期释放。
本系统评价旨在确定在疑似或确诊ACS患者中，HFABP水平在加入既定风险评估方法后是否能改善风险分层。
我们检索了从数据库建立至2015年7月的Medline、Pubmed和Embase数据库，以识别有疑似或确诊ACS且在首次入院期间测量了HFABP并至少有1个月随访数据的前瞻性研究。预后事件定义为全因死亡率或急性心肌梗死（AMI）。
7项试验提供了6935例患者的数据，符合纳入标准。各研究之间存在相当大的差异，这在HFABP升高的预后影响差异中表现明显（死亡的比值比范围为1.2 - 15.2）。所有研究均表明，HFABP可提供未经调整的预后信息，只有一项研究在调整协变量后该信息被否定。肌钙蛋白阴性且HFABP正常的组合导致事件发生率非常低。没有研究评估HFABP超出标准风险评分的增量价值。只有一项研究使用了高敏肌钙蛋白检测。
各研究中HFABP在ACS中的预后影响存在显著异质性，这反映了采样时间和人群风险的差异。在高敏肌钙蛋白时代，对疑似ACS进行HFABP早期采样的前瞻性研究对于确定HFABP的临床价值是必要的。目前，HFABP不应在临床上用作疑似ACS患者的预后标志物。
