Patented biomarker for cardiac injury. 

Derivation and validation of a 0/1h-algorithm to diagnose myocardial infarction using cMyC – direct comparison to hs-cTnI

Study

Cardiac myosin-binding protein C (cMyC) is a cardiac-restricted protein, more abundant than Troponin (cTn) and released rapidly following AMI. We have pre- viously demonstrated more effective rule-out/rule-in of AMI using a single blood sample at presentation.

This study, aimed to (i) derive and validate a 0/1h-triage-algorithm to diagnose AMI based on cMyC and (ii) compare it to the well-established ESC 0/1h-algorithm using hs-cTnI.

Enrolling patients presenting with suspected AMI to the ED, cMyC (Erenna) and hs-cTnI (Architect) were determined at baseline and after one hour. Patients with STEMI were excluded.
The best performing cMyC cut-off combination:

Rule-out
0h <10 (for patients presenting >3h after chest pain onset)
OR
0h <26 AND Δ0–1h <8

Rule-in
≥136
OR
Δ0–1h ≥15 for rule-in (all values ng/L)

was selected in a derivation cohort and applied to the validation cohort (n=695).

Result

cMyC AMI rule out/in algorithm identifies a greater proportion of patients suitable for safe rule-out as compared with the ESC 0/1h-algorithm using hs-cTnI.

cMyC safely rules out more than twice as many patients at first test at arrival to the ED compared with hs-cTnI.

Totally after 1hr repeat test cMyC rules out 10% more patients compared with hs-cTnI.

cMyC reduces the number of patients in a diagnostic grey zone (Observation).

After 1hr repeat test cMyC rules-out/rules-in 11% more patients compared with hs-cTnI.

cMyC rule-in the same amount of patients at the same time as hs-cTnI.
Rule-out Pathway Performance. cMyC safely rules out more than twice as many patients with a single first test at arrival to the ED compared with hs-cTnI.