Heart-Type Fatty Acid Binding Protein as a marker of reperfusion after thrombolytic therapy

Accurate, rapid, and simple noninvasive measures of infarct-related artery (IRA) patency are needed to identify patients with failed coronary reperfus ion for rescue percutaneous coronary intervention (PCI). Heart-type Fatty A cid Binding Protein (H-FABP) is a small, cytosolic protein found in high co ncentrations in the myocardium. We evaluated the efficacy of H-FABP as a ma rker for successful reperfusion after thrombolysis. Fifty-eight subjects fr om the TIMI 14 trial had H-FABP and myoglobin concentrations measured at ba seline (immediately prior to thrombolysis) and 60, 90, and 180 min after th rombolysis. All patients underwent coronary angiography at 90 min. By 60 mi n after thrombolysis, median concentrations of H-FABP and myoglobin were si gnificantly higher in patients with a patent IRA than in those with an occl uded IRA (P < 0.01 for each). Similarly, the 60 and 90 min/baseline H-FABP and myoglobin ratios were significantly higher among patients with a patent IRA (P < 0.01 for each). There were no significant differences in marker c oncentrations or ratios between patients with TIMI grade 2 and TIMI grade 3 flow. The area under the ROC curve tended to be greater for the 60 and 90 min/baseline myoglobin ratios than for similar ratios of H-FABP (0.71 and 0 .73 vs. 0.64 and 0.62; P = ns). In conclusion, successful reperfusion can b e detected within the first 60 min after thrombolysis with either H-FABP or myoglobin. Despite a Favorable kinetic profile, however, H-FABP does not a ppear to represent a significant advance over myoglobin in the noninvasive detection of reperfusion after thrombolysis. (C) 2000 Elsevier Science B.V. All rights reserved.