Rationale for the early clinical application of markers of ischemia in patients with suspected acute coronary syndromes.
Mandates for more rapid treatment of patients with acute myocardial infarction (AMI) are driving public education initiatives aimed at having patients present earlier in the course of their symptoms. This will make it less likely that markers of necrosis will provide the level of diagnostic sensitivity needed. In fact, the goal is to identify and treat these patients sooner in order to prevent necrosis from occurring. Given the limitations of the standard 12-lead ECG to detect ischemia, other technologies are being evaluated: the value of echocardiography and technetium-based myocardial perfusion imaging have been proven. However, the goal is to develop a simple, rapid-turn-around biochemical marker that can provide this same function, and clear progress is being made toward this end. Emergent, rapid restoration of blood flow via pharmacologic revascularization or primary percutaneous interventions can reduce morbidity and mortality when applied in the setting of acute myocardial injury seen on the ECG. Exciting new research suggests that the protection of myocytes against ischemic injury is possible if initiated early, which can limit cellular damage and improve clinical outcomes. Thus, the ability to rapidly detect ischemia will have profound therapeutic possibilities that could further reduce the morbidity and mortality associated with acute coronary syndrome.
Jesse
R L
RL
Virginia Commonwealth University Health System, Medical College of Virginia Hospitals, McGuire Veteran Affairs Medical Center, Richmond, VA 23298-0281, USA. rjesse@hsc.vcu.edu
Kukreja
R
R
D000208:Acute Disease; D015415:Biomarkers; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000628:therapy
D015415:Biomarkers