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


Abstract

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%.