A 0/1h-algorithm using cardiac myosin-binding protein C for early diagnosis of myocardial infarction
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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; Mueller, Christian; APACE Investigators.
In: EUR HEART J-ACUTE CA, Vol. 11, No. 4, 07.06.2022, p. 325-335.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - A 0/1h-algorithm using cardiac myosin-binding protein C for early diagnosis of myocardial infarction
AU - Kaier, Thomas E
AU - Twerenbold, Raphael
AU - Lopez-Ayala, Pedro
AU - Nestelberger, Thomas
AU - Boeddinghaus, Jasper
AU - Alaour, Bashir
AU - Huber, Iris-Martina
AU - Zhi, Yuan
AU - Koechlin, Luca
AU - Wussler, Desiree
AU - Wildi, Karin
AU - Shrestha, Samyut
AU - Strebel, Ivo
AU - Miro, Oscar
AU - Martín-Sánchez, Javier F
AU - Christ, Michael
AU - Kawecki, Damien
AU - Keller, Dagmar I
AU - Rubini Gimenez, Maria
AU - Marber, Michael
AU - Mueller, Christian
AU - APACE Investigators
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2022/6/7
Y1 - 2022/6/7
N2 - 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.
AB - 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.
KW - Algorithms
KW - Biomarkers
KW - Carrier Proteins
KW - Early Diagnosis
KW - Humans
KW - Myocardial Infarction/diagnosis
KW - Non-ST Elevated Myocardial Infarction/diagnosis
KW - Prospective Studies
KW - Troponin T
U2 - 10.1093/ehjacc/zuac007
DO - 10.1093/ehjacc/zuac007
M3 - SCORING: Journal article
C2 - 35149868
VL - 11
SP - 325
EP - 335
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 4
ER -
