Review of: Ecollan, P, Collet JP, Boon G, et al: "Pre-hospital detection of acute myocardial infarction with ultra-rapid human fatty acid-binding protein (H-FABP) immunoassay." International Journal of Cardiology. In Press. Nov 9, 2006.
Throughout Europe, prehospital care is provided by emergency medicine physicians, but there may be much to learn from how they approach the care of their patients. This study from Paris examined the potential value of various bedside, point of care (POC) and blood tests to detect cardiac enzymes in patients with chest pain. The study was designed specifically to compare a new POC test for Human Fatty Acid Binding Protein (H-FABP) with those that detect Troponin I and myoglobin.
What the authors discovered was that the test could with reasonable accuracy identify which patients with normal ECGs would go on to have an infarction. This test was even more likely to be positive in those patients with ST segment elevation than those that measured Troponin I or myoglobin because the H-FABP rises within 30 minutes of the onset of myocardial ischemia.
In the United States, we have only scraped the tip of the iceberg when it comes to aggressively identifying prehospital acute coronary syndromes. Most EMS services, including ALS, don't perform prehospital 12-leads, let alone bedside testing for cardiac enzymes. We simply give them some aspirin, nitro and a fast ride to the hospital.
But with today's proliferation of cardiac centers with rapid response cath labs, it is vital that we identify these patients as quickly as possible, so that resources can be mobilized to care for them. EMS may have options of which hospital to transport to, whether or not to call for an ALS intercept, or to have the receiving hospital arrange for air medical transport upon arrival.
For those services using 12-leads, the added value of POC cardiac enzyme testing can mean the difference in deciding where to transport the non-ST segment elevation MI patient.