A 0/1h-algorithm using cardiac myosin-binding protein C for early diagnosis of myocardial infarction.

Kaier, Thomas E; Twerenbold, Raphael; Lopez-Ayala, Pedro; Nestelberger, Thomas; Boeddinghaus, Jasper; Alaour, Bashir; Huber, Iris-Martina; Zhi, Yuan; Koechlin, Luca; Wussler, Desiree; Wildi, Karin; Shrestha, Samyut; Strebel, Ivo; Miro, Oscar; Martín-Sánchez, Javier F; Christ, Michael; Kawecki, Damien; Keller, Dagmar I; Rubini Gimenez, Maria; Marber, Michael; ... (2022). A 0/1h-algorithm using cardiac myosin-binding protein C for early diagnosis of myocardial infarction. European heart journal. Acute cardiovascular care, 11(4), pp. 325-335. Oxford University Press 10.1093/ehjacc/zuac007

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AIMS

Cardiac myosin-binding protein C (cMyC) demonstrated high diagnostic accuracy for the early detection of non-ST-elevation myocardial infarction (NSTEMI). Its dynamic release kinetics may enable a 0/1h-decision algorithm that is even more effective than the ESC hs-cTnT/I 0/1 h rule-in/rule-out algorithm.

METHODS AND RESULTS

In a prospective international diagnostic study enrolling patients presenting with suspected NSTEMI to the emergency department, cMyC was measured at presentation and after 1 h in a blinded fashion. Modelled on the ESC hs-cTnT/I 0/1h-algorithms, we derived a 0/1h-cMyC-algorithm. Final diagnosis of NSTEMI was centrally adjudicated according to the 4th Universal Definition of Myocardial Infarction. Among 1495 patients, the prevalence of NSTEMI was 17%. The optimal derived 0/1h-algorithm ruled-out NSTEMI with cMyC 0 h concentration below 10 ng/L (irrespective of chest pain onset) or 0 h cMyC concentrations below 18 ng/L and 0/1 h increase <4 ng/L. Rule-in occurred with 0 h cMyC concentrations of at least 140 ng/L or 0/1 h increase ≥15 ng/L. In the validation cohort (n = 663), the 0/1h-cMyC-algorithm classified 347 patients (52.3%) as 'rule-out', 122 (18.4%) as 'rule-in', and 194 (29.3%) as 'observe'. Negative predictive value for NSTEMI was 99.6% [95% confidence interval (CI) 98.9-100%]; positive predictive value 71.1% (95% CI 63.1-79%). Direct comparison with the ESC hs-cTnT/I 0/1h-algorithms demonstrated comparable safety and even higher triage efficacy using the 0h-sample alone (48.1% vs. 21.2% for ESC hs-cTnT-0/1 h and 29.9% for ESC hs-cTnI-0/1 h; P < 0.001).

CONCLUSION

The cMyC 0/1h-algorithm provided excellent safety and identified a greater proportion of patients suitable for direct rule-out or rule-in based on a single measurement than the ESC 0/1h-algorithm using hs-cTnT/I.

TRIAL REGISTRATION

ClinicalTrials.gov number, NCT00470587.

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5 Citations in Web of Science ®
6 Citations in Scopus

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