Measurement of heart-type fatty acid-binding protein before discharge.

plasm of cardiomyocytes. Therefore, H-FABP is released more quickly than the troponins into the circulation when membrane integrity is compromised in response to myocardial injury. Levels of H-FABP are detectable as early as 2–3 h and typically return to baseline levels within 12–24 h of the initial insult.9,10 Consistent with these findings, a growing number of studies have shown that H-FABP is a sensitive marker for the diagnosis of MI and might be more sensitive than troponin assays when measured in the early hours after symptom onset.11 To date, H-FABP seems to provide incremental information for risk stratification that is independent of established risk factors and biomarkers such as cardiac troponin, B-type natriuretic peptide, and myoglobin. Recent studies have shown that elevated H-FABP in the acute phase of MI is associated with an increased risk of cardiac events.12,13 However, few reports have investigated the clinical significance of H-FABP level in the convalescent phase of MI. One of the features of the current study8 was to clarify this issue. A total of 1,283 patients were subjected to blood sampling for determination of H-FABP concentrations at a median of 20 days after the onset of MI. The optimal cut-off value for discriminating all-cause mortality was estimated to be 6.08 ng/ml with a C-statistic of 0.68, which was a little less than the cutoff value for H-FABP to diagnose MI of 6.20 ng/ml. During a median follow-up period of 1,785 days, Kaplan-Meier curves showed that patients with elevated H-FABP levels had a significantly higher incidence of death (18.3% vs 3.8%, P<0.001) and readmission for heart failure (10.3% vs 2.6%, P<0.001) than those without. Multivariate Cox regression analyses also espite significant advances in interventional and pharmacological therapies, late mortality after acute myocardial infarction (MI) is still high.1 Survivors of MI face a substantial excess risk of further cardiac events. Therefore, it is very important to perform risk stratification for the long-term management of MI patients before discharge. The long-term prognosis for an individual varies markedly depending on the presence or absence of adverse cardiovascular factors, including left ventricular (LV) dysfunction, residual ischemia, or ventricular arrhythmias.2 Indeed, the 2008 guidelines of the Japanese Circulation Society for the management of patients with ST-elevation MI recommended that assessment of such adverse prognostic factors should be completed during the index hospitalization or early after discharge. However, a simpler and more convenient method for evaluation of long-term prognosis has been desired.