心肌肌球蛋白结合蛋白C与心肌肌钙蛋白在急性心肌梗死早期诊断中的直接比较

Direct Comparison of Cardiac Myosin-Binding Protein C With Cardiac Troponins for the Early Diagnosis of Acute Myocardial Infarction.

作者信息

Kaier Thomas E, Twerenbold Raphael, Puelacher Christian, Marjot Jack, Imambaccus Nazia, Boeddinghaus Jasper, Nestelberger Thomas, Badertscher Patrick, Sabti Zaid, Giménez Maria Rubini, Wildi Karin, Hillinger Petra, Grimm Karin, Loeffel Sarah, Shrestha Samyut, Widmer Dayana Flores, Cupa Janosch, Kozhuharov Nikola, Miró Òscar, Martín-Sánchez F Javier, Morawiec Beata, Rentsch Katharina, Lohrmann Jens, Kloos Wanda, Osswald Stefan, Reichlin Tobias, Weber Ekkehard, Marber Michael, Mueller Christian

机构信息

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 Network Research on Rare Diseases Instituto de Salud Carlos III, Hospital del Mar-IMIM, Barcelona, Spain (K.W.); Emergency Department, Hospital Clinic, Barcelona, Spain (O.M.); Global Research in Acute Conditions Network (O.M., F.J.M.S., B.M., C.M.); Emergency Department, Hospital Clinico San Carlos, Madrid, Spain (F.J.M.S.); 2nd Cardiology Department, Zabrze, University Silesia, Katowice, Poland (B.M.); Laboratory Medicine, University Hospital Basel, Switzerland (K.R.); and Institute of Physiological Chemistry, Martin Luther University Halle-Wittenberg, Germany (E.W.).

出版信息

Circulation. 2017 Oct 17;136(16):1495-1508. doi: 10.1161/CIRCULATIONAHA.117.028084. Epub 2017 Sep 26.

DOI:10.1161/CIRCULATIONAHA.117.028084

PMID:28972002

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5642333/

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, <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 (<0.0001) and 0.926 (=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 (<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 <0.001). Comparing the C statistics, cMyC was superior to hs-cTnI and standard sensitivity cTnI (<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.

摘要

背景

心肌肌球蛋白结合蛋白C（cMyC）是一种心脏特异性蛋白，其含量比心肌肌钙蛋白（cTn）更丰富，在急性心肌梗死（AMI）后释放速度更快。我们评估了cMyC作为cTn在AMI早期诊断中的辅助或替代指标。

方法

未经过筛选的1954例因疑似AMI症状就诊于急诊科的患者，在就诊时检测了cMyC浓度以及高敏（hs）和标准灵敏度cTn。使用所有可用的临床和生化信息独立判定AMI的最终诊断，且不了解cMyC检测结果。预后终点为长期死亡率。

结果

最终诊断为AMI的患者有340例（17%）。有AMI的患者就诊时cMyC浓度显著高于无AMI的患者（中位数分别为237 ng/L和13 ng/L，P<0.001）。通过受试者工作特征曲线下面积（AUC）量化的对AMI的鉴别能力，cMyC（AUC为0.924）、hs-cTnT（AUC为0.927）和hs-cTnI（AUC为0.922）相当，且优于采用当代灵敏度检测法检测的cTnI（AUC为0.909）。cMyC与hs-cTnT或标准灵敏度cTnI（而非hs-cTnI）联合使用可使AUC分别增加至0.931（P<0.0001）和0.926（P=0.003）。使用cMyC通过单次血液检测能更准确地将患者分类为排除或纳入类别：净重新分类改善相对于hs-cTnT为+0.149，相对于hs-cTnI为+0.235（P<0.001）。在早期就诊者（胸痛<3小时）中，与hs-cTnT（净重新分类改善+0.256）和hs-cTnI（净重新分类改善+0.308；均P<0.001）相比，cMyC在排除/纳入分类方面的改善更大。比较C统计量，在预测3年死亡率方面，cMyC优于hs-cTnI和标准灵敏度cTnI（两者均P<0.05），与hs-cTnT相似。