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The UtiLitY of cardiac myosin binding protein C in the Early triage of low risk patients with Suspected acute coronary syndromes (ULYCES)

Dr Cara Barnes, Institution: University of Western Australia

2018 Vanguard Grant

Years funded: 2019-2021


Acute chest pain is one of the commonest causes of presentation to Emergency Departments (EDs) nationally and worldwide. The majority (>75%) of these individuals are at low risk of serious complications, with only a small proportion ultimately diagnosed with an acute coronary syndrome (ACS) or other major pathology. The consequences of misdiagnosis are, however, potentially catastrophic. Thus, considerable time and resources are expended to ensure the accurate triage of such patients. Recent data suggest that patients with very low levels of high sensitivity troponin (hs-cTn; a very sensitive and specific blood marker of cardiac injury) on arrival to ED (the majority of all those with presenting with chest pain) are at extremely low risk and could potentially be safely and quickly discharged. There are, however, as yet no studies that have actually tested this strategy.

We are currently doing so in a project funded by Western Australia Department of Health, the Single Troponin Accelerated Triage of Chest Pain (STAT Chest Pain) study. While hs-Tn is very useful in the assessment of patients with chest pain, and fundamental to the diagnosis of acute myocardial infarction (MI), it has limitations. In particular, it takes some time to rise after the onset of symptoms. Recently a new, seemingly equally sensitive and specific, biomarker that can detect MI has been identified; cardiac myosin-binding protein C (cMyC). Theoretically, this has advantages over hs-Tn in patients presenting very early because it rises more quickly after heart cells die.

The current study will use the infrastructure established for the STAT Chest Pain study to compare the utility of cMyC with that of hsTnI in the early assessment of low risk patients presenting to an ED with chest pain. We anticipate that cMyC will be particularly useful in patients who present soon (<2 hours) after the onset of symptoms and can potentially be used to allow the prompt but safe discharge of low risk patients.

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