Prognostic value of combining cardiac myosin-binding protein C and N-terminal pro-B-type natriuretic peptide in patients without acute coronary syndrome treated at medical cardiac intensive care units.

We investigated the prognostic value of cardiac myosin-binding protein C (cMyC), a novel cardiospecific marker, both independently and in combination with N-terminal pro-B-type natriuretic peptide (NT-proBNP), for predicting 6-month all-cause mortality in patients without acute coronary syndrome (ACS) treated at medical (nonsurgical) cardiac intensive care units (CICUs). Admission levels of cMyC, high-sensitivity cardiac troponin T (hs-cTnT), and NT-proBNP were measured in 1032 consecutive patients (mean age; 70 years) without ACS hospitalized acutely in medical CICUs for the treatment of cardiovascular disease. Serum cMyC was closely correlated with hs-cTnT and moderately with NT-proBNP (r = 0.92 and r = 0.49, respectively, p < 0.0001). During the 6-month follow-up period after admission, there were 109 (10.6%) all-cause deaths, including 72 cardiovascular deaths. Both cMyC and NT-proBNP were independent predictors of 6-month all-cause mortality (all p < 0.05). Combining cMyC and NT-proBNP with a baseline model of established risk factors improved patient classification and discrimination beyond any single biomarker (all p < 0.05) or the baseline model alone (both p < 0.0001). Moreover, patients were divided into nine groups using cMyC and NT-proBNP tertiles, and the adjusted hazard ratio (95% confidence interval) for 6-month all-cause mortality in patients with both biomarkers in the highest vs. lowest tertile was 9.67 (2.65-35.2). When cMyC was replaced with hs-cTnT, similar results were observed for hs-cTnT. In addition, the C-indices for addition of cMyC or hs-cTnT to the baseline model were similar (0.798 vs. 0.800, p = 0.94). In conclusion, similar to hs-cTnT, cMyC at admission may be a potent, independent predictor of 6-month all-cause mortality in patients without ACS treated at medical CICUs, and their prognostic abilities may be comparable. Combining cMyC or hs-cTnT with NT-proBNP may substantially improve early risk stratification of this population.
Competing Interests: Declarations. Conflict of interest: Dr Nishimura reports no conflicts. Dr J. Ishii received a research grant from Sysmex Corp. Mr. Takahashi, Mr. Ishihara, Mr. Nakamura, Mr. Kitagawa, and Dr Sakaguchi report no conflicts. Ms. Sasaki is an employee of Sysmex R&D Center Europe GmbH. Dr Kawai, Dr Muramatsu, Dr Harada, Dr Yamada, Dr Tanizawa-Motoyama, Dr Naruse, Dr Sarai, and Dr Yanase report no conflicts. Dr H. Ishii received honoraria from AstraZeneca KK, Bayer Pharmaceutical Co., Ltd., Boehringer Ingelheim Japan, Bristol-Myers Squibb Inc., Daiichi-Sankyo Pharma Inc., Kowa, MSD K. K., Mitsubishi Tanabe Pharma Co., Ltd., Mochida Pharmaceutical Co., Ltd., Novartis Japan, Otsuka Pharmaceutical Co. Ltd., and Pfizer Japan Inc. Dr Watanabe reports no conflicts. Dr Ozaki received research grants from Takeda Pharmaceutical Co. Ltd., Sanofi KK, Mitsubishi Tanabe Pharma Corp., Otsuka Pharmaceutical Co. Ltd., Bayer Yakuhin, Ltd., Daiichi Sankyo Co. Ltd., Sumitomo Dainippon Pharma Co. Ltd., and Public Health Research Foundation. Dr Izawa received research grants from grant support through his institution from Bayer Yakuhin Ltd., Sumitomo Pharma Co. Ltd., PDR Pharma Co. Ltd., Biotronik Japan Co Ltd, Abbott Japan Co. Ltd., Boston Scientific Japan Co. Ltd., Japan Lifeline Co. Ltd., and Medtronic Japan Co. LtD., and honoraria for lectures from Otsuka Pharmaceutical Co. Ltd., Novartis Co. Cool., Eli Lilly Japan Co. Ltd., Bayer Yakuhin, Co. Ltd., Nippon Boehringer Ingelheim Co. Ltd., and Daiichi Sankyo Co. Ltd.
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