Author + information
- Thomas Edward Kaiera,b,
- Raphael Twerenbolda,b,
- Christian Puelachera,b,
- Jack Marjota,b,
- Nazia Imambaccusa,b,
- Jasper Boeddinghausa,b,
- Thomas Nestelbergera,b,
- Karin Wildia,b,
- Maria Rubinia,b,
- Tobias Reichlina,b,
- Michael Marbera,b and
- Christian Muellera,b
Background: Cardiac myosin binding protein C (cMyC) is a cardiac-restricted protein that is more abundant than Troponin (cTn) and is released rapidly following Acute Myocardial Infarction (AMI). We evaluated the performance of cMyC as a tool for rapid rule-in/rule-out of AMI.
Methods: cMyC and hs-cTn were measured at presentation to the emergency department (1954 unselected patients, symptoms suggestive of AMI; assays Roche Elecsys, Abbott Architect). Final diagnosis: adjudicated by 2 independent cardiologists with all available clinical information and hs-cTnT/I results. Bootstrapping was used to calculate performance of classification function, net reclassification improvement (NRI) to compare performance at triage.
Results: Concentrations of cMyC at 0h were significantly higher in AMI (n=340 [17%]; median 237ng/L vs 13ng/L, p <0.001). Diagnostic accuracy of cMyC was comparable to hs-cTnT/I. At 10 ng/L for rule-out, cMyC achieves a sensitivity of 99.7% (NPV 99.8%); at 120 ng/L for rule-in, specificity is 95.2% (PPV 72.8%). cMyC was more effective at triage with a single blood test when compared to the hs-cTn 0h/1h-algorithm: NRI (non-events) was 7.9% and 23% for cMyC vs hs-cTnT and hs-cTnI, respectively, translating into a greatly improved rule-out performance; rule-in was better (NRI 6.5%) than hs-cTnT (p<0.001 for all comparisons).
Conclusions: cMyC has high diagnostic utility. It would enhance triage of chest pain and allow immediate discharge of 8-23% more patients with a single blood draw.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-320
- 2017 American College of Cardiology Foundation