Yildirim Mustafa, Salbach Christian, Mueller-Hennessen Matthias, Frey Norbert, Giannitsis Evangelos
Department of Internal Medicine III, Cardiology University Hospital of Heidelberg Heidelberg Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim Heidelberg Germany.
J Am Heart Assoc. 2025 May 20;14(10):e039379. doi: 10.1161/JAHA.124.039379. Epub 2025 May 13.
This study compared the diagnostic and prognostic performance of various non-ST-segment myocardial infarction (NSTEMI) rule-out protocols, incorporating cardiac myosin-binding protein C (cMyBP-C), high-sensitivity cardiac troponin T (hs-cTnT), and Copeptin, both individually and as part of dual-marker strategies (DMSs) against the European Society of Cardiology 0/1-hour and 0/3-hour algorithms.
We enrolled 1765 patients presenting to the emergency department with suspected NSTEMI. We evaluated biomarker algorithms including cMyBP-C (<10 ng/L, <2.3 ng/L), hs-cTnT (limit of blank [<3 ng/L], limit of detection [<5 ng/L], 99th percentile [≤14 ng/L]), and DMS combinations of copeptin (<10 pmol/L) with hs-cTnT, cMyBP-C with hs-cTnT, and copeptin with cMyBP-C. The European Society of Cardiology 0/1-hour and 0/3-hour algorithms were also tested. We calculated negative predictive values and sensitivities for NSTEMI rule-out and assessed effectiveness and prognostic performance based on cardiovascular events within 30 days and 1 year.
The areas under the curve were 0.922 for hs-cTnT, 0.917 for cMyBP-C, and 0.624 for copeptin in diagnosing NSTEMI. DMS protocols showed negative predictive values of 99.1% to 100%, comparable with the European Society of Cardiology algorithms (99.3%-100%). Sensitivities for DMS ranged from 96.2% to 100%. All protocols had low rates of the combined end point of cardiovascular events within 30 days (0.0%-0.6%).
The European Society of Cardiology 0/1-hour algorithm and DMS combining hs-cTnT with either cMyBP-C or copeptin provide highly reliable and safe protocols for NSTEMI rule-out. These DMS approaches offer promising alternatives to current standards, potentially improving clinical decision making and efficiency in emergency departments.
URL: https://clinicaltrials.gov; Unique identifier: NCT06128317.
本研究比较了各种非ST段抬高型心肌梗死（NSTEMI）排除方案的诊断和预后性能，这些方案单独或作为双标志物策略（DMS）的一部分纳入了心肌肌球蛋白结合蛋白C（cMyBP-C）、高敏心肌肌钙蛋白T（hs-cTnT）和 copeptin，并与欧洲心脏病学会的0/1小时和0/3小时算法进行了对比。
我们纳入了1765例因疑似NSTEMI就诊于急诊科的患者。我们评估了生物标志物算法，包括cMyBP-C（<10 ng/L，<2.3 ng/L）、hs-cTnT（空白限[<3 ng/L]、检测限[<5 ng/L]、第99百分位数[≤14 ng/L]）以及copeptin（<10 pmol/L）与hs-cTnT、cMyBP-C与hs-cTnT、copeptin与cMyBP-C的DMS组合。还测试了欧洲心脏病学会的0/1小时和0/3小时算法。我们计算了NSTEMI排除的阴性预测值和敏感性，并基于30天和1年内的心血管事件评估了有效性和预后性能。
在诊断NSTEMI时，hs-cTnT的曲线下面积为0.922，cMyBP-C为0.917，copeptin为0.624。DMS方案的阴性预测值为99.1%至100%，与欧洲心脏病学会算法（99.3%-100%）相当。DMS的敏感性范围为96.2%至100%。所有方案在30天内的心血管事件复合终点发生率均较低（0.0%-0.6%）。
欧洲心脏病学会的0/1小时算法以及将hs-cTnT与cMyBP-C或copeptin相结合的DMS为NSTEMI排除提供了高度可靠和安全的方案。这些DMS方法为当前标准提供了有前景的替代方案，可能改善急诊科的临床决策和效率。
