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Introduction Coronary artery disease (CAD) remains a leading cause of mortality in the UK, with approximately 2.3 million individuals affected and an estimated 100,000 annual hospital admissions for myocardial infarction (MI). Acute coronary syndrome (ACS), caused by sudden coronary artery obstruction, commonly presents with chest pain and associated symptoms,including dyspnoea, nausea, and diaphoresis. While diagnosis relies on clinical assessment, electrocardiography, imaging, and cardiac troponins, early biomarker detection is critical to optimise clinical management. Cardiac myosin-binding protein C (cMyC), a structural component of the cardiac contractile apparatus, is more abundant in cardiomyocytes than cardiac troponin I or T and is rapidly released following myocardial injury. These properties suggest that cMyC may serve as a sensitive early biomarker of myocardial damage, with potential utility in acute clinical settings and as a prognostic marker for subclinical myocardial injury.Materials and Methods The study population comprised 46 healthy controls and 55 anonymised patient samples. Serum samples from patients who tested positive for troponin were used to measure circulating concentrations of cardiac myosin-binding protein C (cMyC). Routine biochemical parameters, including glucose, cholesterol, triglycerides, albumin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine, were measured in both groups. Demographic variables (age and gender), troponin levels, and cMyC concentrations were compared between the patient and control groups, alongside clinical chemistry parameters. No additional clinical data were analysed; however, all patient samples were obtained from individuals presenting with chest pain and confirmed troponin positivity using serial sampling. The Mann–Whitney U test was used to assess statistical significance, and receiver operating characteristic (ROC) analysis was performed to evaluate the diagnostic performance of cMyC.Results and Conclusions Mean cardiac myosin-binding protein C (cMyC) concentrations were significantly higher in troponin T-positive patients (27.58 ± 17.26 ng/L) compared with healthy controls (9.60 ± 6.02 ng/L) as shown in figure 1. Notably, elevated cMyBP-C levels were also detected in serial samples from patients who initially tested negative for troponin. Receiver operating characteristic (ROC) analysis (figure 2) demonstrated an area under the curve (AUC) of 0.908, indicating excellent discriminatory performance of cMyBP-C in patients with negative troponin at admission (McNemar’s test p <0.001). These findings suggest that cMyBP-C is a promising prognostic biomarker and may have clinical utility for early diagnosis, particularly during serial sampling in patients presenting with initially negative troponin results.Abstract 329 Figure 1Serum cMyBP-C levels in patients presenting with chest pain and healthy controls.Abstract 329 Figure 2ROC analysis of cMyC (AUC-0.908)