Comparison between Certain Parameters for Diagnosis of Acute Myocardial Infarction

Background and Objective: The identification and diagnosis of acute myocardial infarction (AMI) in patients presented with chest pain pose significant challenges, as the rate of missed AMI cases among patients who present to the emergency department remain inappropriately high. The aim of this work was to study the performance of three cardiac biomarkers, these are heart-type fatty acid binding protein (HFABP), troponin I (3rd generation TOSOH AIA pack-assay) and myoglobin, for early identification of acute myocardial infarction. Material and Methods: This study was designed as a case –control study. Participants were divided into two groups, the first one included 82 patients diagnosed to have AMI and the second group included 50 apparently healthy control subjects. Troponin I and myoglobin were measured by AIA-Pack assays from TOSOH bioscience while H-FABP was measured by ELISA technique. Results: The area under the curve (AUC) for troponin I was the highest between the tested biomarkers (0.972 ± 0.012) compared with H-FABP and myoglobin which were found to be (0.968 ± 0.013) and (0.921±0.022) respectively. Furthermore, by using the optimal cut-off values of the tested biomarkers, the sensitivity of H-FABP was the highest for those patients presented within the first six hours of the onset of chest pain (90.6%), followed by troponion I and myoglobin (81.3% and 78.1% respectively). From the other hand, the sensitivity of troponin I was the highest (98%) for those patients presented after the sixth hour up to 12 hours from the onset of chest pain compared by H-FABP and myoglobin (90% and 78% respectively). Conclusion: The present study demonstrates that both improved sensitivity troponin I assay and H-FABP can provide valuable information for the diagnosis of AMI. However, for those patients who presented within the first 6 hours of the onset of chest pain, H-FABP will provide superior sensitivity, as application of an early biomarker potentially reduces diagnostic uncertainty for patients with suspected AMI that allow an earlier initiation of treatment, while for those patients who presented later after the 6th hour up to 12 hours of the onset of chest pain, it is more appropriate to use troponin I assay as it provide higher sensitivity. Key words: Acute Myocardial Infarction, Heart-type fatty acid binding protein, Myoglobin &Troponin I.