Incremental Value of Cardiac Myosin-Binding Protein C for the Early Diagnosis of Acute Myocardial Infarction
Authors' conclusion
CMyC adds significant incremental value to hs-cTn values in the early diagnosis of NSTEMI, improving diagnostic discrimination and enabling more patients to be safely and immediately ruled out for NSTEMI.
Study context
- Population
- Adults presenting to the emergency department (ED) with suspected NSTEMI854 (18%) with NSTEMI
- Participants
- 4,735 adults
- Comparison
- cMyC vs high-sensitivity cardiac troponin T (hs-cTnT)
- Primary endpoint
- Index NSTEMI (diagnostic endpoint)
- Follow-up
- ED presentation
Methodological detailsinternational, multicentre, central adjudication blinded to cMyC, external validation cohort, Final diagnoses centrally adjudicated by 2 independent cardiologists blinded to cMyC, Findings externally validated in an independent international cohort
- International
- Multicentre
- Central adjudication blinded to cMyC
- External validation cohort
- Final diagnoses centrally adjudicated by 2 independent cardiologists blinded to cMyC
- Findings externally validated in an independent international cohort
Primary result
As reported in the abstract
Discrimination for NSTEMI at presentation
| Group | AUC |
|---|---|
| cMyC | 0.943 (95% CI: 0.936-0.95) |
| hs-cTnT | 0.936 (95% CI: 0.929-0.944) |
AUC
cMyC0.943 (95% CI: 0.936-0.95)
hs-cTnT0.936 (95% CI: 0.929-0.944)
- cMyC vs hs-cTnT: P = 0.008
Further findings
| Outcome | cMyC | hs-cTnT | P value | |
|---|---|---|---|---|
| Discrimination for NSTEMI, chest pain onset ≤3 h (subgroup)cMyC vs hs-cTnT · differences mainly driven by this subgroup | P < 0.001 | |||
| AUC | 0.939 [95% CI: 0.928-0.951] | 0.921 [95% CI: 0.907-0.936] | ||
| Overall triage efficacy (proportion triaged to rule-out or rule-in) · index visit | Not reported in the abstract | 26.8% | cMyC: not reported in the abstract |
- Overall triage efficacy (proportion triaged to rule-out or rule-in): hs-cTnT and cMyC 60.0%
Overall triage efficacy (proportion triaged to rule-out or rule-in) · index visit
- Dual-biomarker strategy identified up to 3 times more patients for rule-out
CV death or MI · 30 days, 1 year and 5 years
- Comparable cumulative incidences with the dual-biomarker strategy
Safety
Safety of rule-out (sensitivity and NPV for index NSTEMI) · index visit
- Dual-biomarker strategy did not compromise safety
Original publication
Incremental Value of Cardiac Myosin-Binding Protein C for the Early Diagnosis of Acute Myocardial Infarction. J Am Coll Cardiol. Published 12 November 2025. doi:10.
Summarised from the published abstract; every number is checked against it