RT Journal Article
SR Electronic
T1 Evaluating possible acute coronary syndrome in primary care: the value of signs, symptoms, and plasma heart-type fatty acid-binding protein (H-FABP). A diagnostic study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP bjgpopen19X101652
DO 10.3399/bjgpopen19X101652
VO 3
IS 3
A1 Robert TA Willemsen
A1 Bjorn Winkens
A1 Bas LJH Kietselaer
A1 Agnieszka Smolinska
A1 Frank Buntinx
A1 Jan FC Glatz
A1 Geert-Jan Dinant
YR 2019
UL http://bjgpopen.org/content/3/3/bjgpopen19X101652.abstract
AB Background Additional diagnostic means could be of added value when evaluating possible acute coronary syndrome (ACS) in primary care.Aim To determine whether heart-type fatty acid-binding protein (H-FABP)-based point-of-care (POC) biomarker testing, embedded in a clinical decision rule (CDR), is helpful to the GP when evaluating possible ACS.Design & setting A prospective, non-randomised, double-blinded, diagnostic derivation study was undertaken, with a delayed-type cross-sectional diagnostic model among GPs in the Netherlands and Belgium.Method Signs and symptoms predicting acute myocardial infarction (AMI) or ACS were identified using both logistic regression analysis, and classification and regression trees (CART). Diagnostic values of the POC H-FABP test (cut-off value 4 ng/ml) alone and as part of a CDR were determined.Results A total of 303 participants (48.8% male) with chest pain or discomfort who had consulted a GP were enrolled. ACS was found in 32 (10.6%) of these 303 patients. For ACS, sensitivity and negative predictive value (NPV) of the POC H-FABP test was 25.8% (95% confidence interval [CI] = 12.5 to 44.9) and 91.6% (95% CI = 87.6% to 94.5%), respectively. The area under the receiver operating curve of the optimal CDR was 0.78 for ACS.Conclusion Sensitivity of the current H-FABP POC test (cut-off value 4 ng/ml) as a stand-alone test is poor, either owing to limitations of the marker or of the test device. Usability of a CDR derived from these results is doubtful: the number of ACS cases missed by the GP is reduced but, as a consequence, disproportionally more ACS-negative patients are referred.