Comparison of hs-cTnI, hs-cTnT, hFABP and GPBB for identifying early adverse cardiac events in patients presenting within six hours of chest pain-onset

摘要

To the Editor: A recent publication comparing and assessing high-sensitivity cardiac troponin T (hs-cTnT) with heart-type fatty-acid binding protein (hFABP) at presentation in a pooled population of patients included in the FAST II (Fast Assessment of Thoracic Pain) and FASTER I (Fast Assessment of Thoracic Pain by nEuRal networks) studies indicated no incremental value for the diagnosis of myocar-dial infarction (MI) with the addition of hFABP to hs-cTnT [1]. An additional study in 3 centers in Germany on patients admitted with suspected acute coronary syndrome (ACS) to chest pain units also suggested limited utility of combining another early biomarker (glycogen phosphorylase BB; GPBB) with a sensitive cardiac troponin I (cTnI) assay for the diagnosis of acute MI [2]. However, neither of these studies assessed peak concentrations on early serial measurements (i.e., at presentation and 3 h, and 6 h later) for the diagnosis of MI as recommended by recent guidelines [3] or for predicting other short-term serious cardiac adverse events. Further work is needed here, as the pathophysiological role of GPBB, an enzyme of cellular metabolism, is believed to be released from its binding to glycogen during conditions of ischemia, which is then rapidly moved into circulation within the first hours of chest pain onset [2].