Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction
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Published:2017-10-17
Issue:16
Volume:136
Page:1495-1508
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ISSN:0009-7322
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Container-title:Circulation
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language:en
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Short-container-title:Circulation
Author:
Kaier Thomas E.1, Twerenbold Raphael1, Puelacher Christian1, Marjot Jack1, Imambaccus Nazia1, Boeddinghaus Jasper1, Nestelberger Thomas1, Badertscher Patrick1, Sabti Zaid1, Giménez Maria Rubini1, Wildi Karin1, Hillinger Petra1, Grimm Karin1, Loeffel Sarah1, Shrestha Samyut1, Widmer Dayana Flores1, Cupa Janosch1, Kozhuharov Nikola1, Miró Òscar1, Martín-Sánchez F. Javier1, Morawiec Beata1, Rentsch Katharina1, Lohrmann Jens1, Kloos Wanda1, Osswald Stefan1, Reichlin Tobias1, Weber Ekkehard1, Marber Michael1, Mueller Christian1
Affiliation:
1. From King’s College London BHF Centre, Rayne Institute, St Thomas’ Hospital, London, UK (T.K., J.M., N.I., M.M.); Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Switzerland (R.T., C.P., J.B., T.N., P.B., Z.S., M.R.G., K.W., P.H., K.G., S.L., S.S., D.F.W., J.C., N.K., J.L., W.K., S.O., T.R., C.M.); Department of General and Interventional Cardiology, University Heart Center Hamburg, Germany (R.T., M.R.G.); Emergency Department, Centre for Biomedical...
Abstract
Background:
Cardiac myosin-binding protein C (cMyC) is a cardiac-restricted protein that is more abundant than cardiac troponins (cTn) and is released more rapidly after acute myocardial infarction (AMI). We evaluated cMyC as an adjunct or alternative to cTn in the early diagnosis of AMI.
Methods:
Unselected patients (N=1954) presenting to the emergency department with symptoms suggestive of AMI, concentrations of cMyC, and high-sensitivity (hs) and standard-sensitivity cTn were measured at presentation. The final diagnosis of AMI was independently adjudicated using all available clinical and biochemical information without knowledge of cMyC. The prognostic end point was long-term mortality.
Results:
Final diagnosis was AMI in 340 patients (17%). Concentrations of cMyC at presentation were significantly higher in those with versus without AMI (median, 237 ng/L versus 13 ng/L,
P
<0.001). Discriminatory power for AMI, as quantified by the area under the receiver-operating characteristic curve (AUC), was comparable for cMyC (AUC, 0.924), hs-cTnT (AUC, 0.927), and hs-cTnI (AUC, 0.922) and superior to cTnI measured by a contemporary sensitivity assay (AUC, 0.909). The combination of cMyC with hs-cTnT or standard-sensitivity cTnI (but not hs-cTnI) led to an increase in AUC to 0.931 (
P
<0.0001) and 0.926 (
P
=0.003), respectively. Use of cMyC more accurately classified patients with a single blood test into rule-out or rule-in categories: Net Reclassification Improvement +0.149 versus hs-cTnT, +0.235 versus hs-cTnI (
P
<0.001). In early presenters (chest pain <3 h), the improvement in rule-in/rule-out classification with cMyC was larger compared with hs-cTnT (Net Reclassification Improvement +0.256) and hs-cTnI (Net Reclassification Improvement +0.308; both
P
<0.001). Comparing the C statistics, cMyC was superior to hs-cTnI and standard sensitivity cTnI (
P
<0.05 for both) and similar to hs-cTnT at predicting death at 3 years.
Conclusions:
cMyC at presentation provides discriminatory power comparable to hs-cTnT and hs-cTnI in the diagnosis of AMI and may perform favorably in patients presenting early after symptom onset.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00470587.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Physiology (medical),Cardiology and Cardiovascular Medicine
Reference40 articles.
1. U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2012 Emergency Department Summary Tables [published online ahead of print May 3 2017]. CDC.gov. http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2012_ed_web_tables.pdf 2. Recent Trends in the Incidence, Treatment, and Outcomes of Patients with STEMI and NSTEMI 3. Early Diagnosis of Myocardial Infarction with Sensitive Cardiac Troponin Assays 4. 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes
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