Background: Chest pain is a non-specific complaint and is the most frequent reason for patients to seek urgent medical attention. The immediate challenge is to be able to identify acutely impaired myocardial perfusion before the necrotic process starts. Myocardial infarction with its complications is one of the most serious challenges in contemporary cardiology. Among biochemical markers of myocardial ischemia, human heart-type free fatty acid binding protein (h-FABP) showed excellent sensitivity and specificity for the early diagnosis of an acute MI as it is released rapidly (30 minutes) from the cardiac myocyte to the circulation in response to myocardial injury; hence it may be useful for rapid confirmation or exclusion of MI. Aim: The purpose of this study is to determine the diagnostic value of (h-FABP) in patients with acute chest pain (within 3 hours from symptom onset) accompanied with ST elevation in ECG and compare it to the standard cardiac biomarkers. Study design and methods: Single-center study included fifty five patients selected from the emergency department in a tertiary center. All patients were subjected to complete medical history, physical examination and full labs including (h-FABP). Transthoracic echocardiogram was done in all the patients. Pharmacological thrombolytic therapy and/or coronary angiography followed by percutaneous coronary intervention (PCI) (rescue or primary) were carried out in these patients. Results: The diagnostic accuracy, sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) for (h-FABP) were evaluated. Our study results showed that there was a higher percentage of (h-FABP) positive results in cases (90.0%) compared to controls (6.7%). There was a highly significant difference between (h-FABP) and (CK-MB) as regard sensitivity in the diagnosis of (STEMI) during 3 hours from the onset of chest pain in admission to ED, as (h-FABP) sensitivity was 90.9% compared to (CK-MB) sensitivity which was 7.3%. There was no significant difference between (h-FABP) (on admission) and (cTn I) at 4-6 hours after admission (90.9% vs. 100%, P value=1.0). There was no significant difference between (h-FABP) and (cTn-I) as regard specificity in the diagnosis of myocardial injury, (93.3% vs. 100%, p=1.0). In regard to the time of presentation to the (ED); there was significant difference between the (h-FABP) positive and the (h-FABP) negative groups; where 80% of the patients of the (h-FABP) negative patients group presented within 60 minutes from the onset of typical ischemic chest pain while no patient from the (h-FABP) positive group presented in this time frame (mean±SD was 59.0±7.42 hours vs. 143.1±29.28). Conclusions: The (h-FABP) seems to be an excellent and sensitive early cardiac biomarker of cardiac ischemia in the group of patients with chest pain lasting less than 3 hours, compared to the other standard cardiac biomarkers (CK, CK-MB and cTn-I).