Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Troponin Values
Niamh Kilcullen, MRCPI*,2,*,
Karthik Viswanathan, MRCP*,3,
Rajiv Das, MRCP*,2,
Christine Morrell*,
Amanda Farrin, MSc ,
Julian H. Barth, MD, FRCP, FRCPath ,1,
Alistair S. Hall, PhD, FRCP*,1 for the EMMACE-2 Investigators
* Coronary Artery Disease Clinical Research Network Group, Leeds Institute for Genetic, Health & Therapeutics, Leeds, United Kingdom
Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
Department of Clinical Biochemistry, General Infirmary at Leeds, Leeds, United Kingdom.
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Figure 1 Kaplan-Meier All-Cause Mortality Curves According to H-FABP Quartiles
Kaplan-Meier all-cause mortality curves according to heart-type fatty acid-binding protein (H-FABP) quartiles (Q). After adjusting for all GRACE risk factors, highly sensitive C-reactive protein (hs-CRP), and troponin I as a continuous variable the following hazard ratios were observed: Q1 1.0, Q2 2.58 (95% confidence interval [CI] 1.37 to 4.85; p = 0.003), Q3 3.77 (95% CI 2.01 to 7.07; p < 0.001), and Q4 6.59 (95% CI 3.40 to 12.74; p < 0.001).
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Figure 2 All-Cause Mortality by TnI and H-FABP Clinical Cutoff Values
(A) Kaplan-Meier mortality curves for patients with either TnI  0.06 µg/l (unstable angina) or TnI >0.06 µg/l (MI inclusive of STEMI/BBBMI) according to the H-FABP cutoff value of 5.8 µg/l. One-year univariable hazard ratios for each group relative to TnI–/H-FABP– patients are: TnI+/H-FABP– 2.38 (95% CI 0.48 to 11.65; p = 0.29), TnI–/H-FABP+ 4.93 (95% CI 1.09 to 22.30; p = 0.038), and TnI+/H-FABP+ 7.11 (1.71 to 29.64; p = 0.007). (B) Cox regression mortality curves for patients with either TnI 0.06 µg/l (unstable angina) or TnI >0.06 µg/l (MI inclusive of STEMI/BBBMI) according to the H-FABP cutoff value of 5.8 µg/l. One-year multivariable (GRACE risk factors plus hs-CRP) hazard ratios for each group relative to TnI–/H-FABP– patients are: TnI+/H-FABP– 2.31 (95% CI 0.49 to 10.90; p = 0.29), TnI–/H-FABP+ 5.21 (95% CI 1.21 to 22.47; p = 0.027), and TnI+/H-FABP+ 7.41 (95% CI 1.83 to 30.00; p = 0.005). BBBMI = bundle branch block myocardial infarction; MI = myocardial infarction; STEMI = ST-segment elevation myocardial infarction; TnI = troponin I; other abbreviations as in Figure 1.
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