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Heart-type fatty acid binding protein as a marker of reperfusion after thrombolytic therapy
J A de Lemos1, E M Antman, D A Morrow
1Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA. jdelemos@rics.bwh.harvard.edu
Insights
Heart-type Fatty Acid Binding Protein (H-FABP) and myoglobin can detect successful coronary reperfusion within 60 minutes after thrombolysis. However, H-FABP offers no significant advantage over myoglobin for noninvasive assessment of infarct-related artery patency.
Area of Science:
- Cardiology
- Biomarkers
- Acute Coronary Syndromes
Background:
- Noninvasive assessment of infarct-related artery (IRA) patency is crucial for identifying patients needing rescue percutaneous coronary intervention (PCI).
- Heart-type Fatty Acid Binding Protein (H-FABP) is a myocardial protein with potential as a reperfusion marker.
Purpose of the Study:
- To evaluate the efficacy of H-FABP as a marker for successful reperfusion after thrombolysis compared to myoglobin.
Main Methods:
- Fifty-eight patients from the TIMI 14 trial had H-FABP and myoglobin measured at baseline and at 60, 90, and 180 minutes post-thrombolysis.
- Coronary angiography was performed at 90 minutes to assess IRA patency.
Main Results:
- By 60 minutes, median H-FABP and myoglobin concentrations and their ratios to baseline were significantly higher in patients with a patent IRA (P<0.01).
- No significant differences in marker levels were found between TIMI grades 2 and 3 flow.
- Myoglobin ratios showed a trend towards better diagnostic performance (higher area under ROC curve) than H-FABP ratios.
Conclusions:
- Both H-FABP and myoglobin can detect successful reperfusion within 60 minutes post-thrombolysis.
- H-FABP does not offer a significant advantage over myoglobin for noninvasive detection of reperfusion after thrombolysis.
Abstract:
Accurate, rapid, and simple noninvasive measures of infarct-related artery (IRA) patency are needed to identify patients with failed coronary reperfusion for rescue percutaneous coronary intervention (PCI). Heart-type Fatty Acid Binding Protein (H-FABP) is a small, cytosolic protein found in high concentrations in the myocardium. We evaluated the efficacy of H-FABP as a marker for successful reperfusion after thrombolysis. Fifty-eight subjects from the TIMI 14 trial had H-FABP and myoglobin concentrations measured at baseline (immediately prior to thrombolysis) and 60, 90, and 180 min after thrombolysis. All patients underwent coronary angiography at 90 min. By 60 min after thrombolysis, median concentrations of H-FABP and myoglobin were significantly higher in patients with a patent IRA than in those with an occluded IRA (P<0.01 for each). Similarly, the 60 and 90 min/baseline H-FABP and myoglobin ratios were significantly higher among patients with a patent IRA (P<0.01 for each). There were no significant differences in marker concentrations or ratios between patients with TIMI grade 2 and TIMI grade 3 flow. The area under the ROC curve tended to be greater for the 60 and 90 min/baseline myoglobin ratios than for similar ratios of H-FABP (0.71 and 0.73 vs. 0.64 and 0.62; P=ns). In conclusion, successful reperfusion can be detected within the first 60 min after thrombolysis with either H-FABP or myoglobin. Despite a favorable kinetic profile, however, H-FABP does not appear to represent a significant advance over myoglobin in the noninvasive detection of reperfusion after thrombolysis.