An Algorithm Based on Combining hs-cTNT and H-FABP for Ruling Out Acute Myocardial Infarction

Cesar Oswaldo Navarro1, Mary Jo Kurth2, Mark Ruddock2, Sam Fishlock1, James McLaughlin1
1Ulster University, 2Randox Laboratories Ltd


Algorithms combining high sensitivity cardiac troponin T (hs-cTnT) and heart-type fatty acid-binding protein (H-FABP) may help in ruling out Acute Myocardial Infarction (AMI). For this purpose, a recent algorithm from our group left hs-cTnT thresholds fixed as those recommended by the ESC guidelines while concentrating on the values of H-FABP. This time, we also explore hs-cTnT values to generate a decision tree combining these two biomarkers.
The results show a significant improvement when compared to previous algorithms reported for Non-ST elevation cases presenting chest pain of suspected cardiac origin. Using a cohort of n=360 patients (n=288 Non-AMI and n=72 NSTEMI), a rule-out algorithm used at presentation identified more ‘low-risk’ patients than the standard ESC algorithm: (199/288 (69.1%) vs. 83/288 (28.8%) (p < 0.0005)), respectively. According to our data, deployment of our algorithm at the emergency department identified additional non-AMI patients over the ESC algorithm, potentially reducing the number of hospital admissions by 42%.