Comparative Analysis of Single‐ and Dual‐Marker Strategies for Rapid Non–ST‐Segment–Elevation Myocardial Infarction Rule‐Out Using Cardiac Myosin‐Binding Protein C, Copeptin, and High‐Sensitivity Cardiac Troponin T in the Emergency Department

• DOI: 10.1161/jaha.124.039379
• Publication Date: 2025-05-13T09:47:43Z
• Authors: Mustafa Yildirim; Christian Salbach; Matthias Mueller‐...; Norbert Frey; Evangelos Giannitsis
• Keywords: Copeptin; Troponin complex; Troponin T

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 troponin T (hs‐cTnT), Copeptin, both individually as part dual‐marker strategies (DMSs) against European Society Cardiology 0/1‐hour 0/3‐hour algorithms. Methods We enrolled 1765 patients presenting to emergency department with suspected NSTEMI. evaluated biomarker algorithms including cMyBP‐C (<10 ng/L, <2.3 ng/L), hs‐cTnT (limit blank [<3 ng/L], limit detection [<5 99th percentile [≤14 ng/L]), DMS combinations copeptin pmol/L) hs‐cTnT, cMyBP‐C. The were also tested. calculated negative predictive values sensitivities for NSTEMI assessed effectiveness based on cardiovascular events within 30 days 1 year. Results areas under curve 0.922 0.917 cMyBP‐C, 0.624 in diagnosing protocols showed 99.1% 100%, comparable (99.3%–100%). Sensitivities ranged from 96.2% 100%. All had low rates combined end point (0.0%–0.6%). Conclusions algorithm combining either or provide highly reliable safe rule‐out. These approaches offer promising alternatives current standards, potentially improving clinical decision making efficiency departments. Registration URL: https://clinicaltrials.gov ; Unique identifier: NCT06128317