Diagnostic and prognostic evaluation of novel biomarkers compared to esc 0/1-hour and 0/3-hour algorithms in patients with suspected non-ST-elevation myocardial infarction

Abstract Background Prompt recognition of acute coronary syndrome (ACS) remains challenging in the emergency setting, especially for non-ST-elevation myocardial infarction (NSTEMI). Purpose To evaluate the diagnostic and prognostic performance of novel biomarkers for NSTEMI compared with guideline-recommended algorithms. Methods We analyzed patients with suspected ACS presenting to our Hospital’s Emergency Department between August 2014 and February 2023. The biomarker panel comprised high-sensitivity cardiac troponin T (hs-cTnT), cardiac myosin-binding protein C (cMyBP-C), pro-B-type natriuretic peptide (proBNP), total N-terminal pro-B-type natriuretic peptide (t-NT-proBNP), angiotensin II (Ang2), bone morphogenetic protein 10 (BMP10), endothelial cell-specific molecule 1 (ESM1), fatty acid-binding protein 3 (FABP3), fibroblast growth factor 23 (FGF23), growth differentiation factor 15 (GDF15), and copeptin. We calculated negative predictive values (NPVs), sensitivities, and areas under the curve (AUCs) for NSTEMI discrimination, and assessed effectiveness and prognostic performance for cardiovascular events at 30 days and 1 year. Results Among 1,765 patients, 212 (12%) had NSTEMI. The ESC 0/1-hour and 0/3-hour algorithms achieved sensitivities of 100% and 96.8%, NPVs of 100% and 99.3%, and effectiveness of 54.8% and 66.0%, respectively. Hs-cTnT (AUC 0.922) and cMyBP-C (AUC 0.917) showed the highest diagnostic accuracy, followed by FABP3 (AUC 0.759) and copeptin (AUC 0.624); other biomarkers performed lower (AUC 0.516–0.617). At 1 year, event rates ranged from 0.0% to 3.4%, with superior prognostic performance for the ESC algorithms (0.8% and 2.4%). Conclusions The ESC 0/1-hour and 0/3-hour algorithms remain the most effective NSTEMI diagnostic strategies, combining high sensitivity, prognostic reliability, and operational effectiveness. Among novel biomarkers, only cMyBP-C demonstrated accuracy comparable to hs-cTnT, supporting its potential as an adjunct to troponin-based assessment.Diagnostic performance of biomarkers. KM survival estimates.