A 0/1h-algorithm using cardiac myosin-binding protein C for early diagnosis of myocardial infarction.
APACE
Cardiac myosin-binding protein C
Myocardial infarction
Troponin I
Troponin T
cMyC
Journal
European heart journal. Acute cardiovascular care
ISSN: 2048-8734
Titre abrégé: Eur Heart J Acute Cardiovasc Care
Pays: England
ID NLM: 101591369
Informations de publication
Date de publication:
07 Jun 2022
07 Jun 2022
Historique:
received:
22
12
2021
revised:
18
01
2022
accepted:
25
01
2022
pubmed:
13
2
2022
medline:
10
6
2022
entrez:
12
2
2022
Statut:
ppublish
Résumé
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. 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). 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. ClinicalTrials.gov number, NCT00470587.
Identifiants
pubmed: 35149868
pii: 6527336
doi: 10.1093/ehjacc/zuac007
pmc: PMC9173679
doi:
Substances chimiques
Biomarkers
0
Carrier Proteins
0
Troponin T
0
myosin-binding protein C
0
Banques de données
ClinicalTrials.gov
['NCT00470587']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
325-335Subventions
Organisme : British Heart Foundation
ID : FS/15/13/31320
Pays : United Kingdom
Organisme : Medical Research Council
ID : G1000737
Pays : United Kingdom
Organisme : Swiss National Science Foundation
Pays : Switzerland
Organisme : British Heart Foundation
ID : TG/15/1/31518, FS/15/13/31320
Pays : United Kingdom
Investigateurs
Michael Freese
(M)
Paul David Ratmann
(PD)
Alexandra Prepoudis
(A)
Danielle M Gualandro
(DM)
Nicolas Geigy
(N)
Tobias Reichlin
(T)
Katharina Rentsch
(K)
Mario Maier
(M)
Valentina Troester
(V)
Juliane Gehrke
(J)
Tania Coscia
(T)
Noemi Glarner
(N)
Hadrien Schoepfer
(H)
Michael Buechi
(M)
Joan Walter
(J)
Ana Yufera Sanchez
(AY)
Christian Puelacher
(C)
Jeanne du Fay de Lavallaz
(J)
Alessandra Sanzione
(A)
Ibrahim Schäfer
(I)
Petra Hillinger
(P)
Beatriz López
(B)
Esther Rodriguez Adrada
(ER)
Piotr Muzyk
(P)
Beata Morawiec
(B)
Jiri Parenica
(J)
Eva Ganovská
(E)
Jens Lohrmann
(J)
Andreas Buser
(A)
Arnold von Eckardstein
(A)
Roland Bingisser
(R)
Christian Nickel
(C)
Informations de copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
Références
Biometrics. 2000 Jun;56(2):345-51
pubmed: 10877288
N Engl J Med. 2009 Aug 27;361(9):858-67
pubmed: 19710484
Circulation. 2018 Oct 16;138(16):1654-1665
pubmed: 30354460
PLoS One. 2017 Nov 9;12(11):e0187662
pubmed: 29121105
Circulation. 2018 Jun 5;137(23):2536-2538
pubmed: 29866778
Eur Heart J. 2021 Apr 7;42(14):1289-1367
pubmed: 32860058
Clin Chem. 2019 Jul;65(7):893-904
pubmed: 30988172
Circulation. 2017 Apr 25;135(17):1597-1611
pubmed: 28283497
Transl Res. 2016 Apr;170:17-25.e5
pubmed: 26713894
Heart. 2016 Aug 15;102(16):1270-8
pubmed: 26955848
Circulation. 2017 Oct 17;136(16):1495-1508
pubmed: 28972002
J Am Coll Cardiol. 2017 Sep 19;70(12):1532-1534
pubmed: 28911517
Eur Heart J Acute Cardiovasc Care. 2019 Aug;8(5):404-411
pubmed: 29199434
Clin Chem. 2017 May;63(5):990-996
pubmed: 28377413
Heart. 2013 May;99(10):708-14
pubmed: 23514979
Eur Heart J. 2018 Jan 7;39(2):119-177
pubmed: 28886621
Clin Chem. 2019 Mar;65(3):437-450
pubmed: 30626633
Basic Res Cardiol. 2015 May;110(3):23
pubmed: 25837837
J Am Coll Cardiol. 2009 Jun 30;54(1):60-8
pubmed: 19555842
J Am Coll Cardiol. 2018 Oct 30;72(18):2231-2264
pubmed: 30153967
Heart. 2018 Apr;104(8):665-672
pubmed: 28864718
Clin Chem. 2016 Aug;62(8):1153-5
pubmed: 27324735
J Am Coll Cardiol. 2018 Aug 7;72(6):620-632
pubmed: 30071991
Int J Cardiol. 2019 May 15;283:41-47
pubmed: 30545622
Eur Heart J Acute Cardiovasc Care. 2017 Apr;6(3):218-222
pubmed: 27370210
J Am Heart Assoc. 2019 Aug 6;8(15):e013152
pubmed: 31345102
Eur Heart J. 2014 Feb;35(6):365-75
pubmed: 23821402
Eur Heart J. 2014 Sep 7;35(34):2303-11
pubmed: 24842285