Cardiac myosin-binding protein-C levels are associated with severity and prognosis in stable coronary artery disease

While cardiac myosin-binding protein-C (cMyBP-C) is a promising biomarker for acute coronary syndrome, its clinical utility in stable coronary artery disease (CAD) remains poorly defined. To investigate the association of cMyBP-C with the presence and angiographic severity of stable CAD, and to evaluate its prognostic value for 1-year major adverse cardiovascular events (MACEs). This study enrolled 367 patients undergoing coronary angiography for suspected CAD. We performed a cross-sectional analysis for CAD presence and severity (quantified by Gensini score [GS]) and a prospective follow-up of stable CAD patients for 1-year MACEs. Of 367 patients, cMyBP-C levels were significantly higher in those with stable CAD (n = 195) versus non-CAD (n = 172) (median 28.0 vs. 6.0 pg/ml, P < 0.001) and correlated positively with GS (r = 0.44, P < 0.001). In multivariate analysis, cMyBP-C was an independent predictor of both CAD presence (odds ratio [OR] 1.06, 95% confidence interval [CI] 1.05-1.08) and severe CAD (GS ≥ 18) (OR 1.03, 95% CI 1.02-1.04; both P < 0.001). The area under the curve for predicting CAD presence and severity was 0.827 and 0.778, respectively. In the prognostic cohort of 190 stable CAD patients, 56 MACEs (29.5%) occurred. As the proportional hazards assumption was violated, an Accelerated Failure Time (AFT) model was used. This model confirmed that a high cMyBP-C level (≥ 27 pg/ml) was independently associated with an accelerated time to MACEs (Acceleration Factor 0.66, 95% CI 0.46-0.94, P = 0.02). Circulating cMyBP-C is an independent predictor for the presence and angiographic severity of stable CAD, and an elevated level identifies patients at higher risk for 1-year MACEs. While these single-center findings require confirmation in larger, external validation cohorts, they position cMyBP-C as a promising biomarker for comprehensive risk stratification in this population.