Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun 7;11(4):325-335.
doi: 10.1093/ehjacc/zuac007.

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

Thomas E Kaier  1 , Raphael Twerenbold  2   3   4 , Pedro Lopez-Ayala  2   3 , Thomas Nestelberger  2   3   5 , Jasper Boeddinghaus  2   3 , Bashir Alaour  1 , Iris-Martina Huber  2   3 , Yuan Zhi  2   3 , Luca Koechlin  2   3   6 , Desiree Wussler  2   3 , Karin Wildi  2   3   7   8 , Samyut Shrestha  2   3 , Ivo Strebel  2   3 , Oscar Miro  2   3   9 , Javier F Martín-Sánchez  2   3   10 , Michael Christ  3   11 , Damien Kawecki  2   3 , Dagmar I Keller  12 , Maria Rubini Gimenez  2   3   13 , Michael Marber  1 , Christian Mueller  2   3 ; APACE Investigators
Collaborators, Affiliations

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

Thomas E Kaier et al. Eur Heart J Acute Cardiovasc Care. .

Abstract

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.

Keywords: APACE; Cardiac myosin-binding protein C; Myocardial infarction; Troponin I; Troponin T; cMyC.

PubMed Disclaimer

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Comparison of cMyC and ESC hs-TnT/I 0/1h-algorithms: direct comparison of patient distribution in the validation cohort according to the cMyC 0/1h-algorithm and the ESC hs-cTnT/I 0/1h-algorithms. Final clinical adjudication of NSTEMI included hs-cTnT.
Figure 2
Figure 2
Dual-marker strategy: Concept outlining how the 0h cMyC concentration could be employed as a triage-booster when integrated into the established ESC 0/1h-algorithm.
Figure 3
Figure 3
Mortality plot: cumulative event plot for the cMyC 0/1h-algorithm, with statistical comparison of event curves at 30 and 365 days with the log-rank tests; table displays number-at-risk and absolute number of events.
See this image and copyright information in PMC

References

    1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P; ESC Scientific Document Group . 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2018;39:119–177. - PubMed
    1. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL, Dendale P, Dorobantu M, Edvardsen T, Folliguet T, Gale CP, Gilard M, Jobs A, Jüni P, Lambrinou E, Lewis BS, Mehilli J, Meliga E, Merkely B, Mueller C, Roffi M, Rutten FH, Sibbing D, Siontis GCM; ESC Scientific Document Group. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 2020;42:1289–1367. - PubMed
    1. Wildi K, Boeddinghaus J, Nestelberger T, Twerenbold R, Badertscher P, Wussler D, Giménez MR, Puelacher C, Du Fay de Lavallaz J, Dietsche S, Walter J, Kozhuharov N, Morawiec B, Miró Ò, Javier Martin-Sanchez F, Subramaniam S, Geigy N, Keller DI, Reichlin T, Mueller C; APACE Investigators . Comparison of fourteen rule-out strategies for acute myocardial infarction. Int J Cardiol 2019;283:41–47. - PubMed
    1. Boeddinghaus J, Nestelberger T, Badertscher P, Twerenbold R, Fitze B, Wussler D, Strebel I, Rubini Giménez M, Wildi K, Puelacher C, Du Fay de Lavallaz J, Oehen L, Walter J, Miró Ò, Martin-Sanchez FJ, Morawiec B, Potlukova E, Keller DI, Reichlin T, Mueller C, Sabti Z, Freese M, Stelzig C, Shrestha S, Schaerli N, Kozhuharov N, Flores D, Lohrmann J, Biskup E, Kloos W, Osswald S, Mueller D, Sazgary L, López B, Adrada ER, Kawecki D, Muzyk P, Nowalany-Kozielska E, Parenica J, Ganovská E, Meissner K, Kulangara C, Mahfouz R, Hartmann B, Ferel I, Campodarve I, Rentsch K, von Eckardstein A, Buser A, Geigy N; Additional APACE Investigators . Predicting acute myocardial infarction with a single blood draw. Clin Chem 2019;65:437–450. - PubMed
    1. Boeddinghaus J, Nestelberger T, Twerenbold Ret al. . High-sensitivity cardiac troponin I assay for early diagnosis of acute myocardial infarction. Clin Chem 2019;65:893–904. - PubMed

Associated data

LinkOut - more resources