Original article
Adult cardiac
Heart-Type Fatty Acid Binding Protein and Ischemia-Modified Albumin for Detection of Myocardial Infarction After Coronary Artery Bypass Graft Surgery

https://doi.org/10.1016/j.athoracsur.2016.10.051Get rights and content

Background

Heart-type fatty acid binding protein (hFABP) and ischemia-modified albumin (IMA) have been put forward as novel biomarkers to detect myocardial injury shortly after onset of ischemia. We compared hFABP and IMA with cardiac troponin I (cTnI) for speed and reliability in the diagnosis of perioperative myocardial infarction (PMI) after coronary artery bypass graft surgery (CABG).

Methods

In all, 210 consecutive patients undergoing isolated CABG with cardiopulmonary bypass were enrolled in a prospective study. Blood samples were taken perioperatively and throughout the first 72 hours after surgery; clinical data and events were recorded. In cohort A, serum concentrations of hFABP and cTnI were measured using a combined quantitative bedside assay. In cohort B, IMA and cTnI serum concentrations were measured using an albumin cobalt binding test. Perioperative myocardial infarction was defined using a cTnI cutoff of greater than 10.5 ng/mL occurring within 24 hours of CABG or new electrocardiographic changes.

Results

In cohort A, 14 patients were identified with PMI (group 1), whereas 94 had no PMI and served as controls (group 2). Both hFABP and cTnI were increased in group 1 as compared with group 2 (p < 0.001). Although cTnI did not differ before 12 hours, hFABP diverged much earlier, at 1 hour postoperatively (p < 0.001). An hFABP concentration of 20 μg/mL at 1 hour detected PMI with an area under the curve of 77.1%. In cohort B, 18 patients were identified with PMI (group 3), and 84 patients served as controls (group 4). No difference in cTnI values could be observed between the groups until 12 hours postoperatively. Ischemia-modified albumin failed to differentiate at any postoperative time point; the low discriminative power of IMA was confirmed with an area under the curve of 53.3% at 1 hour, 48.5% at 6 hours, and 39.3% at 12 hours postoperatively.

Conclusions

Heart-type fatty acid binding protein is a sensitive and rapid biomarker that detected PMI reliably at 1 hour after CABG, much earlier than cTnI. The diagnostic value of IMA for detection of PMI appears to be very limited in this setting.

Section snippets

Patients

Between January 2010 and April 2013, a total of 210 patients were prospectively enrolled in the study. Patients were consequently assigned without randomization into two main study groups, cohort A or cohort B. All patients gave written informed consent, and the study was performed with Institutional Ethics Committee approval. All patients more than 18 years of age with double- or triple-vessel coronary artery disease who were scheduled for elective, isolated, primary CABG surgery with

Results

In all, 210 consecutive patients undergoing elective, isolated, primary CABG with cardiopulmonary bypass were enrolled in a prospective study. Figure 1 shows the study design. Of the 210 patients enrolled, 108 patients were allocated to cohort A to investigate hFABP in comparison with cTnI, and 104 patients were allocated to cohort B to investigate IMA in comparison with cTnI in patients with and patients without PMI after CABG. Patients were consecutively allocated without randomization to

Comment

The main results from the present prospective pilot study in two cohorts with a total of 210 multivessel coronary artery disease patients undergoing elective, isolated, on-pump CABG surgery can be summarized as follows.

Heart-type fatty acid binding protein is a sensitive and very early biomarker for myocardial ischemia or infarction, and is significantly elevated in patients with PMI after elective, isolated on-pump CABG. We demonstrated that hFABP not only differentiates with a high level of

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      hFABP is primarily found in cardiac myocytes so it is more specific for cardiac myocyte necrosis. One recent trial compared the utility of IMA and hFABP versus cardiac troponin for myocardial infarction after coronary artery bypass grafting.6 This trial showed that hFABP was more sensitive than IMA for detecting postoperative myocardial infarction and was detected sooner than cardiac troponin I.6 However, another large trial showed that hFABP did not aid in the diagnosis of non-ST elevated myocardial infarctions over cardiac troponin.7

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