PT - JOURNAL ARTICLE AU - Carroll, Christopher AU - Al Khalaf, Mohamad AU - Stevens, John W AU - Leaviss, Joanna AU - Goodacre, Steve AU - Collinson, Paul O AU - Wang, Jenny TI - Heart-type fatty acid binding protein as an early marker for myocardial infarction: systematic review and meta-analysis AID - 10.1136/emermed-2012-201174 DP - 2013 Apr 01 TA - Emergency Medicine Journal PG - 280--286 VI - 30 IP - 4 4099 - http://emj.bmj.com/content/30/4/280.short 4100 - http://emj.bmj.com/content/30/4/280.full SO - Emerg Med J2013 Apr 01; 30 AB - Background Heart-type fatty acid binding protein (H-FABP) has been proposed as an early biomarker of myocardial infarction (MI). The authors aimed to undertake a systematic review and meta-analysis to estimate the early sensitivity and specificity of quantitative and qualitative H-FABP assays. Methods The authors undertook a systematic search using electronic databases, citation lists and expert contacts to identify all diagnostic cohort studies of patients presenting with suspected acute coronary syndrome that compared H-FABP at presentation to a reference standard based on the Universal definition of MI. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Meta-analysis was conducted using Bayesian Markov chain Monte Carlo simulation. Results The authors included eight studies of quantitative H-FABP and nine studies of qualitative H-FABP. The summary estimates of sensitivity and specificity were 81% (95% prediction interval 50% to 95%) and 80% (26% to 98%) respectively for the quantitative assays and 68% (11% to 97%) and 92% (20% to 100%) respectively for the qualitative assays. Four studies reported the sensitivity of troponin and H-FABP at presentation in which the combination was considered positive if either test was positive. The addition of H-FABP to troponin increased sensitivity from 42–75% to 76–97% but decreased specificity from 94–100% to 65–93%. Conclusion H-FABP has modest sensitivity and specificity for MI at presentation but estimates are subject to substantial uncertainty and primary data are subject to substantial heterogeneity. H-FABP may have a role alongside troponin in improving early sensitivity but comparison with high sensitivity troponin assays is required.