Prognostic Value of Heart‐Type Fatty Acid‐Binding Protein in Patients With Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis

Abstract

Introduction Heart‐type fatty acid‐binding protein (H‐FABP) is rapidly released following myocardial injury, but its prognostic significance in acute coronary syndrome (ACS) remains uncertain. We evaluated the association between elevated H‐FABP and adverse clinical outcomes in confirmed or suspected ACS. Methods PubMed, Embase, CENTRAL, Web of Science and Scopus were searched from inception to 30 August 2026 without date restriction. Studies assessing diagnostic and/or prognostic relevance of circulating H‐FABP in adults with confirmed or suspected ACS were eligible. Prognostic outcomes included all‐cause mortality, major adverse cardiovascular events (MACE), heart failure (HF)–related hospitalisation and recurrent myocardial infarction (MI). Risk of bias was assessed using QUIPS. Crude odds ratios (ORs) from extractable 2 × 2 event data were pooled using inverse‐variance random‐effects models with restricted maximum‐likelihood estimation. Results Twelve studies were included, with five contributing to meta‐analysis. Elevated H‐FABP was associated with higher odds of all‐cause mortality (OR 5.68; 95% CI 3.98–8.09; I 2 = 30%), MACE (OR 4.56; 95% CI 1.97–10.55; I 2 = 47%), HF‐related hospitalisation (OR 4.29; 95% CI 2.94–6.26; I 2 = 0%) and recurrent MI (OR 1.65; 95% CI 1.15–2.37; I 2 = 0%). Pooled estimates were unadjusted; seven studies were synthesised narratively. Conclusion Elevated H‐FABP is associated with adverse outcomes in ACS, but current evidence does not establish independent prognostic value. Further prospective studies should determine whether H‐FABP adds predictive value beyond established clinical and biochemical risk markers.