Comparing combined testing of cMyBP-C and hs-cTnT with other algorithms for rapid rule-out of acute myocardial infarction in suspected acute coronary syndrome patients

Comparing combined testing of cMyBP-C and hs-cTnT with other algorithms for rapid rule-out of acute myocardial infarction in suspected acute coronary syndrome patients

Abstract Background We aimed to compare the diagnostic accuracy of a dual-marker strategy (DMS), incorporating cardiac myosin-binding protein C (cMyBP-C) and high-sensitivity cardiac troponin T (hs-cTnT) testing, against other rapid rule-out algorithms for acute myocardial infarction (AMI). Methods...

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Veröffentlicht in:European heart journal 2024-10, Vol.45 (Supplement_1)
Hauptverfasser: Yildirim, M, Salbach, C, Milles, B R, Biener, M, Frey, N, Mueller-Hennessen, M, Giannitsis, E
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container_title European heart journal
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creator Yildirim, M
Salbach, C
Milles, B R
Biener, M
Frey, N
Mueller-Hennessen, M
Giannitsis, E
description Abstract Background We aimed to compare the diagnostic accuracy of a dual-marker strategy (DMS), incorporating cardiac myosin-binding protein C (cMyBP-C) and high-sensitivity cardiac troponin T (hs-cTnT) testing, against other rapid rule-out algorithms for acute myocardial infarction (AMI). Methods We enrolled 2059 patients presenting to the emergency department with suspected AMI and compared diagnostic measures using the DMS (cMyBP-C
doi_str_mv 10.1093/eurheartj/ehae666.1601
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Methods We enrolled 2059 patients presenting to the emergency department with suspected AMI and compared diagnostic measures using the DMS (cMyBP-C <10 ng/L and hs-cTnT≤14 ng/L), serial hs-cTnT sampling (hs-cTnT<14ng/L at different time points within 1-3h), modified European Society of Cardiology (ESC) 0/1h- or 0/3h-protocol (hs-cTnT<5ng/L or <12ng/L & ∆hs-cTnT<3ng/L at 1h or <7ng/L at 3h if hs-cTnT at 1h was not available), as well as the hs-cTnT limit-of-blank (LoB, <3ng/L) and -detection (LoD, <5ng/L) were compared. Negative predictive values (NPV) and sensitivities for AMI rule-out were assessed. Results True-negative rule-out rates using the DMS ranged from 38.1% to 51.6% across all patients, surpassing rates of 6.2%, 17.4%, 45%, and 50.8% achieved by LoB, LoD, serial hs-cTnT sampling, and ESC 0/1h or 0/3h algorithms, respectively. The DMS demonstrated an NPV of 99.7%, similar to serial hs-cTnT sampling and ESC 0/1h or 0/3h algorithms, and 100% for both LoB and LoD. Sensitivities were 98.9%, 98.9%, 100%, and 100%, respectively. Conclusions The DMS - incorporating cMyBP-C and hs-cTnT - effectively rules out AMI, showing non-inferiority to hs-cTnT-only-based rapid rule-out algorithms and offers a promising alternative, potentially enhancing clinical decision-making in emergency settings.]]></description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehae666.1601</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>European heart journal, 2024-10, Vol.45 (Supplement_1)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Yildirim, M</creatorcontrib><creatorcontrib>Salbach, C</creatorcontrib><creatorcontrib>Milles, B R</creatorcontrib><creatorcontrib>Biener, M</creatorcontrib><creatorcontrib>Frey, N</creatorcontrib><creatorcontrib>Mueller-Hennessen, M</creatorcontrib><creatorcontrib>Giannitsis, E</creatorcontrib><title>Comparing combined testing of cMyBP-C and hs-cTnT with other algorithms for rapid rule-out of acute myocardial infarction in suspected acute coronary syndrome patients</title><title>European heart journal</title><description><![CDATA[Abstract Background We aimed to compare the diagnostic accuracy of a dual-marker strategy (DMS), incorporating cardiac myosin-binding protein C (cMyBP-C) and high-sensitivity cardiac troponin T (hs-cTnT) testing, against other rapid rule-out algorithms for acute myocardial infarction (AMI). Methods We enrolled 2059 patients presenting to the emergency department with suspected AMI and compared diagnostic measures using the DMS (cMyBP-C <10 ng/L and hs-cTnT≤14 ng/L), serial hs-cTnT sampling (hs-cTnT<14ng/L at different time points within 1-3h), modified European Society of Cardiology (ESC) 0/1h- or 0/3h-protocol (hs-cTnT<5ng/L or <12ng/L & ∆hs-cTnT<3ng/L at 1h or <7ng/L at 3h if hs-cTnT at 1h was not available), as well as the hs-cTnT limit-of-blank (LoB, <3ng/L) and -detection (LoD, <5ng/L) were compared. Negative predictive values (NPV) and sensitivities for AMI rule-out were assessed. Results True-negative rule-out rates using the DMS ranged from 38.1% to 51.6% across all patients, surpassing rates of 6.2%, 17.4%, 45%, and 50.8% achieved by LoB, LoD, serial hs-cTnT sampling, and ESC 0/1h or 0/3h algorithms, respectively. The DMS demonstrated an NPV of 99.7%, similar to serial hs-cTnT sampling and ESC 0/1h or 0/3h algorithms, and 100% for both LoB and LoD. Sensitivities were 98.9%, 98.9%, 100%, and 100%, respectively. Conclusions The DMS - incorporating cMyBP-C and hs-cTnT - effectively rules out AMI, showing non-inferiority to hs-cTnT-only-based rapid rule-out algorithms and offers a promising alternative, potentially enhancing clinical decision-making in emergency settings.]]></description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqNkMlOwzAQQC0EEqXwC8g_kNbO4iRHiNikIjjkwC2aemlcJXZkO0L5In6TRK04c5pF82ZGD6F7SjaUlMlWjq6V4MJxK1uQjLENZYReoBXN4jgqWZpdohWhZRYxVnxdoxvvj4SQglG2Qj-V7Qdw2hwwt_1eGylwkD4sDaswf58eP6MKgxG49RGvTY2_dWixDa10GLqDdXPZe6ysww4GLbAbOxnZMSw88DFI3E-WgxMaOqyNAseDtmZOsR_9IHmYb54GuXXWgJuwn4xwtpd4gKClCf4WXSnovLw7xzWqn5_q6jXafby8VQ-7iBcljWLIy7TgORFlnvEyTUSRJrRQkAjOiyxPci5ysS9ZLIQqUjLLSajKGJUpBVA0WSN2Wsud9d5J1QxO9_NHDSXNYrv5s92cbTeL7RmkJ9COw3-ZX1l_jIc</recordid><startdate>20241028</startdate><enddate>20241028</enddate><creator>Yildirim, M</creator><creator>Salbach, C</creator><creator>Milles, B R</creator><creator>Biener, M</creator><creator>Frey, N</creator><creator>Mueller-Hennessen, M</creator><creator>Giannitsis, E</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20241028</creationdate><title>Comparing combined testing of cMyBP-C and hs-cTnT with other algorithms for rapid rule-out of acute myocardial infarction in suspected acute coronary syndrome patients</title><author>Yildirim, M ; Salbach, C ; Milles, B R ; Biener, M ; Frey, N ; Mueller-Hennessen, M ; Giannitsis, E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c891-2a7948c70d975c943d84318fa3dcc85737cd7db962ddf84096431f561e41aaf13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yildirim, M</creatorcontrib><creatorcontrib>Salbach, C</creatorcontrib><creatorcontrib>Milles, B R</creatorcontrib><creatorcontrib>Biener, M</creatorcontrib><creatorcontrib>Frey, N</creatorcontrib><creatorcontrib>Mueller-Hennessen, M</creatorcontrib><creatorcontrib>Giannitsis, E</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yildirim, M</au><au>Salbach, C</au><au>Milles, B R</au><au>Biener, M</au><au>Frey, N</au><au>Mueller-Hennessen, M</au><au>Giannitsis, E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparing combined testing of cMyBP-C and hs-cTnT with other algorithms for rapid rule-out of acute myocardial infarction in suspected acute coronary syndrome patients</atitle><jtitle>European heart journal</jtitle><date>2024-10-28</date><risdate>2024</risdate><volume>45</volume><issue>Supplement_1</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract><![CDATA[Abstract Background We aimed to compare the diagnostic accuracy of a dual-marker strategy (DMS), incorporating cardiac myosin-binding protein C (cMyBP-C) and high-sensitivity cardiac troponin T (hs-cTnT) testing, against other rapid rule-out algorithms for acute myocardial infarction (AMI). Methods We enrolled 2059 patients presenting to the emergency department with suspected AMI and compared diagnostic measures using the DMS (cMyBP-C <10 ng/L and hs-cTnT≤14 ng/L), serial hs-cTnT sampling (hs-cTnT<14ng/L at different time points within 1-3h), modified European Society of Cardiology (ESC) 0/1h- or 0/3h-protocol (hs-cTnT<5ng/L or <12ng/L & ∆hs-cTnT<3ng/L at 1h or <7ng/L at 3h if hs-cTnT at 1h was not available), as well as the hs-cTnT limit-of-blank (LoB, <3ng/L) and -detection (LoD, <5ng/L) were compared. Negative predictive values (NPV) and sensitivities for AMI rule-out were assessed. Results True-negative rule-out rates using the DMS ranged from 38.1% to 51.6% across all patients, surpassing rates of 6.2%, 17.4%, 45%, and 50.8% achieved by LoB, LoD, serial hs-cTnT sampling, and ESC 0/1h or 0/3h algorithms, respectively. The DMS demonstrated an NPV of 99.7%, similar to serial hs-cTnT sampling and ESC 0/1h or 0/3h algorithms, and 100% for both LoB and LoD. Sensitivities were 98.9%, 98.9%, 100%, and 100%, respectively. Conclusions The DMS - incorporating cMyBP-C and hs-cTnT - effectively rules out AMI, showing non-inferiority to hs-cTnT-only-based rapid rule-out algorithms and offers a promising alternative, potentially enhancing clinical decision-making in emergency settings.]]></abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehae666.1601</doi></addata></record>
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title Comparing combined testing of cMyBP-C and hs-cTnT with other algorithms for rapid rule-out of acute myocardial infarction in suspected acute coronary syndrome patients
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