INTRODUCTION Ischemic heart disease is one of the leading causes of death all over the world and hence early diagnosis of acute coronary syndrome is crucial in prognosis. Heart type fatty acid binding protein (H–FABP) is recently studied as an early cardiac marker for the diagnosis of acute myocardial infarction. AIM OF THE STUDY To assess the role of heart type fatty acid binding protein in the early diagnosis of ST elevation Myocardial infarction (STEMI)  and to compare its diagnostic efficacy with cardiac Troponin T. METHODOLOGY 75 patients who were diagnosed to have STEMI within 6 hours of onset of symptoms by WHO Definition of Myocardial infarction were included in the study and their ECG, Echocardiogram, Troponin T and H–FABP (qualitative immunological rapid test) were analysed RESULTS H–FABP is useful for earlier diagnosis of STEMI and it is more sensitive and specific in diagnosis of STEMI than Troponin T in patients presenting < 6 hours of onset of symptoms.