期刊
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
卷 11, 期 4, 页码 325-335出版社
OXFORD UNIV PRESS
DOI: 10.1093/ehjacc/zuac007
关键词
Cardiac myosin-binding protein C; cMyC; Troponin I; Troponin T; Myocardial infarction; APACE
资金
- Swiss National Science Foundation
- European Union
- Swiss Heart Foundation
- University of Basel
- University Hospital Basel
- Abbott
- Brahms
- Beckman Coulter
- Quidel
- Ortho Clinical Diagnostics
- Roche
- Singulex
- Siemens
- Medical Research Council (London, UK) [G1000737]
- Guy's and St Thomas' Charity (London, UK) [R060701, R100404]
- British Heart Foundation (Birmingham, London) [TG/15/1/31518, FS/15/13/31320]
- UK Department of Health through the National Institute for Health Research Biomedical Research Centre
- NIHR clinical lectureship [CL-2019-17-006]
Cardiac myosin-binding protein C (cMyC) has shown high diagnostic accuracy in the early detection of non-ST-elevation myocardial infarction (NSTEMI). Its dynamic release kinetics may enable a more effective 0/1h-decision algorithm compared to current ESC hs-cTnT/I algorithm.
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.
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