Can cMyc challenge cTn?

Area of Science:

• Cardiology
• Biomarker Discovery
• Diagnostic Medicine

Background:

• Early diagnosis of acute coronary syndrome (ACS) is crucial but challenging.
• High-sensitivity cardiac troponin (hs-cTn) has limitations in the initial hours post-symptom onset.
• Cardiac myosin-binding protein C (cMyc) emerges as a promising, earlier, and more specific biomarker for ACS.

Purpose of the Study:

• To evaluate cardiac myosin-binding protein C (cMyc) as an early diagnostic biomarker for acute coronary syndrome (ACS).
• To compare the diagnostic performance of cMyc against high-sensitivity cardiac troponin (hs-cTn).
• To explore the utility of cMyc in various clinical settings, including myocardial infarction subtyping and heart failure.

Main Methods:

• Comparative analyses of cMyc versus hs-cTn in multicenter studies.
• Integration of cMyc testing into 0/1-hour diagnostic algorithms.
• Assessment of cMyc's performance in myocardial infarction subtyping, cardiac surgery, heart failure, and prehospital settings.

Main Results:

• Cardiac myosin-binding protein appears in circulation within 30 minutes of ischemia, peaking significantly faster than hs-cTn.
• In non-ST-segment elevation myocardial infarction, cMyc combined with hs-cTn improved rule-out rates from 10.9% to 41.9%.
• The cardiac-specific N-terminal fragment (C0C1f) of cMyc minimizes false positives, and point-of-care testing feasibility was demonstrated with a 70-minute turnaround.

Conclusions:

• Cardiac myosin-binding protein demonstrates superior early diagnostic capability for ACS compared to hs-cTn.
• cMyc has the potential to significantly transform current diagnostic paradigms for acute coronary syndrome.
• The biomarker also shows prognostic value in heart failure and cardiac surgery contexts.