Evaluating the diagnostic utility of heart-type fatty acid-binding protein as a novel biomarker for acute coronary syndrome in the emergency department: A 1-year cross-sectional study

ABSTRACT Background: Acute myocardial infarction (AMI) and related cardiac conditions are leading global causes of mortality. Timely diagnosis and intervention in AMI are vital; however, existing biochemical markers such as myoglobin, creatine kinase-MB (CK-MB), and troponins have limitations in early detection. Heart-type fatty acid-binding protein (H-FABP), abundant in cardiac tissue, has emerged as a potential early biomarker for AMI. This study evaluates the diagnostic efficacy of H-FABP compared to troponin-T (Trop-T) and CK-MB, aiming to establish H-FABP as a reliable biomarker for early acute coronary syndrome (ACS) diagnosis. Methods: This prospective comparative cross-sectional study was conducted at KLES Dr. Prabhakar Kore Hospital from January to December 2023, enrolling 50 patients presenting with chest pain suggestive of ACS. Laboratory assessments were executed for cardiac Trop-T, CK-MB, and H-FABP. Trop-T and CK-MB levels were measured upon presentation and again 6–12 h postadmission, while H-FABP was qualitatively assessed at presentation only. Data on symptoms and medical history were recorded. Laboratory analyses utilized electrochemiluminescence immunoassay for Trop-T and CK-MB and rapid chromatographic immunoassay for H-FABP. The primary outcome was sensitivity for diagnosing ACS within the initial 3-h window, with secondary outcomes including specificity, positive predictive value, and negative predictive value. Results: The mean age was 52.68 ± 12 years, with a significant male predominance (74.4% in AMI). Typical chest pain was reported by 80% of patients. H-FABP showed 76.92% sensitivity, 100% specificity, and a highly significant P < 0.0001 within the 3-h window, while Trop-T’s sensitivity improved over time from 35.90% at presentation to 84.60% at 6–12 h. CK-MB exhibited moderate sensitivity (43.59% at presentation and 66.70% at 6–12 h) and significant specificity (100%). Conclusion: This study highlights clinical and diagnostic differences between AMI and UA. H-FABP demonstrated high diagnostic accuracy during the early hours of presentation, suggesting its potential as a valuable early biomarker for ACS diagnosis. However, larger multicentric studies are necessary to validate these findings before routine clinical adoption.