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

APACE Investigators

doi:10.1093/ehjacc/zuac007

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

APACE Investigators

Cardiovascular Research

Department of Cardiology, BHF Centre of Research Excellence, King's College London, London, United Kingdom .
Department of Cardiology, Cardiovascular Division, King's College London, The Rayne Institute, St Thomas' Hospital, London, UK.
King's College London & Guy's and St Thomas' PET Centre, St Thomas' Hospital, London, SE1 7EH, U.K.
Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland.; Department of Ophthalmology, University of Basel, Basel, Switzerland.; Department of Genetics and Genome Biology, University of Leicester, Leicester, UK.
Great Ormond St Hosp Children NHS Fdn Trust, NIHR Clin Res Network North Thames, Somers Clin Res Facil
University Children's Hospital

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

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.

Original language	English
Journal	European heart journal. Acute cardiovascular care
DOIs	https://doi.org/10.1093/ehjacc/zuac007
Publication status	E-pub ahead of print - 12 Feb 2022

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10.1093/ehjacc/zuac007

Cite this

@article{74e256be6be1404f8933816ad4bcf70a,

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

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.",

author = "{APACE Investigators} and Kaier, {Thomas E} and Raphael Twerenbold and Pedro Lopez-Ayala and Thomas Nestelberger and Jasper Boeddinghaus and Bashir Alaour and Iris-Martina Huber and Yuan Zhi and Luca Koechlin and Desiree Wussler and Karin Wildi and Samyut Shrestha and Ivo Strebel and Oscar Miro and Mart{\'i}n-S{\'a}nchez, {Javier F} and Michael Christ and Damien Kawecki and Keller, {Dagmar I} and {Rubini Gimenez}, Maria and Michael Marber and Christian Mueller",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2022",

month = feb,

day = "12",

doi = "10.1093/ehjacc/zuac007",

language = "English",

journal = "European heart journal. Acute cardiovascular care",

issn = "2048-8726",

publisher = "SAGE Publications Ltd",

}

TY - JOUR

T1 - A 0/1h-algorithm using cardiac myosin-binding protein C for early diagnosis of myocardial infarction

AU - APACE Investigators

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

PY - 2022/2/12

Y1 - 2022/2/12

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.

U2 - 10.1093/ehjacc/zuac007

DO - 10.1093/ehjacc/zuac007

M3 - Article

C2 - 35149868

SN - 2048-8726

JO - European heart journal. Acute cardiovascular care

JF - European heart journal. Acute cardiovascular care

ER -

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

Abstract

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