A Comparison of Different Combination Regimens of Biochemical Markers in Diagnosing Acute Myocardial Infarction_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Peng , ZHENG Lei , ZENG Fangyin , LIU Jie ,  WANG Qian

Center of Laboratory Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China;

Corresponding author：

WANG Qian, Email: wangqian@fimmu.com

Keywords：

Myocardial infarction; Biochemical marker; Diagnosis

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Objective 　To compare the diagnostic accuracy of different combination regimens of myocardial infarction markers in diagnosing acute myocardial infarction; and to estimate the effect of heart-type fatty acid-binding protein (H-FABP) in improving the diagnostic accuracy of the combinations.
Methods 　Patients with acute onset of chest pain were included randomly. Serum concentrations of H-FABP and other biochemical markers for myocardial infarction (cTnI, Myo) were determined immediately, and then acute myocardial infarction (AMI) patients were defined according to the WHO criteria. ROC curves for three biochemical markers were established respectively, and the cutoff values of the three markers were determined accordingly. Three combination regimens of myocardial infarction markers for AMI diagnosis were designed: cTnI+Myo, cTnI+H-FABP, cTnI+H-FABP+Myo. Diagnostic accuracy of the three regimens were then calculated and compared.
Results 　The AUCs for the three biochemical markers were AUCcTnI 0.938 (95%CI: 0.888-0.988), AUCMyo 0.743 (95%CI: 0.651-0.836), and AUCH-FABP 0.919 (95%CI: 0.873-0.964), respectively. AUCH-FABP was significantly larger than AUCMyo (P lt;0.01). The cutoff values of the three biochemical markers for diagnosing AMI were defined as CutoffcTnI 0.5 ng/mL, CutoffMyo 90 ng/mL, and CutoffH-FABP 5.7 ng/mL, respectively. The diagnostic accuracy of these markers and their combination regimens were calculated and presented as follows (cTnI, Myo, H-FABP, cTnI+Myo, cTnI+H-FABP, cTnI+Myo+H-FABP): sensitivity: 0.804, 0.674, 0.783, 0.957, 0.957 and 0.957; specificity: 0.966, 0.747, 0.954, 0.724, 0.92 and 0.724; diagnostic efficacy: 0.910, 0.722, 0.895, 0.805, 0.932 and 0.805, respectively. Compared with the combination of cTnI+H-FABP, the sensitivities of cTnI (Z=2.261, P=0.024), Myo (Z=3.497, P lt;0.001) and H-FABP (Z=2.478, P=0.013) were significantly lower; the specificities of Myo (Z=3.062, P=0.002), cTnI+Myo (Z=3.378, P lt;0.001) and cTnI+Myo+H-FABP (Z=3.378, P lt;0.001) were significantly lower; and the diagnostic efficacies of Myo (Z=4.528, P lt;0.001), cTnI+Myo (Z=3.064, P=0.002) and cTnI+Myo+H-FABP (Z=3.064, P=0.002) were significantly lower.
Conclusion 　The combination regimen of cTnI+H-FABP which includes H-FABP as the sensitive marker seems to be more effective than the currently used combinations in diagnosing AMI in patients with acute onset of chest pain.

Citation： ZHANG Peng,ZHENG Lei,ZENG Fangyin,LIU Jie,WANG Qian. A Comparison of Different Combination Regimens of Biochemical Markers in Diagnosing Acute Myocardial Infarction. Chinese Journal of Evidence-Based Medicine, 2006, 06(11): 777-782. doi: Copy

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1. 张鹏, 王前, 郑磊, 等. 心肌型脂肪酸结合蛋白早期诊断急性冠脉综合征. 南方医科大学学报, 2006; 26(3): 358~360.
2. 刘关键, 吴泰相. 诊断性试验的Meta分析——SROC 曲线法介绍. 中国循证医学杂志, 2003; 3(1): 41~44.
3. 吴泰相, 刘关键, 王家良. 医学检验方法学研究的设计和文献评价原则. 中华检验医学杂志, 2000; 23(6): 379~381.
4. Glatz JF, Storch J. Unravelling the significance of cellular fatty acid-binding proteins. Curr Opin Lipidol, 2001; 12(3): 267–274.
5. Ishii J, Wang JH, Naruse H, et al. Serum concentrations of myoglobin vs human heart-type cytoplasmic fatty acid-binding protein in early detection of acute myocardial infarction. Clin Chem, 1997; 43(8): 1372–1378.
6. Zhang P, Wang Q, Zheng L, et al. Heart-type fatty acid-binding protein detection for early diagnosis of acute coronary syndrome. J South Med Univ, 2006; 26(3): 358–360.
7. Okamoto F, Sohmiya K, Ohkaru Y, et al. Human heart-type cytoplasmic fatty acid-binding protein (H-FABP) for the diagnosis of acute myocardial infarction. Clinical evaluation of H-FABP in comparison with myoglobin and creatine kinase isoenzyme MB. Clin Chem Lab Med, 2000; 38(3): 231–238.
8. Chan CPY, Sanderson JE, Glanz JFC, et al. A super early myocardial infarction marker--Human heart type fatty acid binding protein. Z Kardiol, 2004; 93: 388–397.
9. Zhou XH, Nancy AO, Donna KM. Statistical methods in diagnostic medicine. New York: Wiley&Sons, Inc., 2002. 36–37.
10. Liu GJ, Wu TX. Summary ROC Curve-diagnostic test method of Meta analysis. Chin J Evidence-Based Medicine, 2003; 3(1): 41–44.
11. Wu TX, Liu GJ, Wang JL. The design and literature appraisal principle of the methodology of laboratory medicine. Chin J Lab Med, 2000; 23(6): 379–381.

Chinese Journal of Evidence-Based Medicine

A Comparison of Different Combination Regimens of Biochemical Markers in Diagnosing Acute Myocardial Infarction

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