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Early identification of acute coronary syndrome (ACS) in the emergency room is still a difficult task. The objective of this study is to estimate the reliability of heart-type fatty acid binding protein (H-FABP) in identifying ACS in the early stage of chest pain onset.In a prospective multicentre study in emergency room patients with suspected ACS lasting less than 3 h, heart heart-type fatty acid binding protein (H-FABP) was compared with conventional biomarkers. Protein levels >7 ng/ml were considered positive results.A total of 419 patients were analyzed. Acute myocardial infarction was diagnosed in 148 patients (35%). H-FABP sensitivity was 60% (89 out of 148 patients), significantly higher than troponin T [19% (28 out of 148 patients); P<0,05]. Specificity of troponin T, however, [99% (270 out of 271 patients)] was better than H-FABP [88% (237 out of 271 patients)], though this was not statistically significant.H-FABP can be a useful early diagnostic biochemical marker, particularly within the first 6 h of symptoms, in patients attending the emergency department.