Comparative Analysis of Single- and Dual-Marker Strategies for Rapid Non-ST-Segment-Elevation Myocardial Infarction
Mustafa Yildirim1,2, Christian Salbach1,2, Matthias Mueller-Hennessen1
1Department of Internal Medicine III, Cardiology University Hospital of Heidelberg Heidelberg Germany.
Background:
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.
Methods:
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.
Results:
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%).
Conclusions:
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.
Registration:
URL: https://clinicaltrials.gov; Unique identifier: NCT06128317.
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