title: [Multi-biomarker approach to acute coronary syndrome].
abstract: High-risk acute coronary syndrome is characterized by vulnerable-plaque with subocclusive thrombus and down-stream microemboli spreading minor myocardial damage, resulting in non-ST-elevation myocardial infarction. Advances in the understanding of the pathogenesis and consequences of acute coronary syndrome have stimulated development of novel biomarkers, and expanded their role in the different spectrum of the underlying pathophysiology, namely multi-biomarker strategy; consisted of biomarkers for 1) myocardial necrosis(membrane damage to myofibril necrosis), 2) plaque destabilization, 3) myocardial stress(ischemic stress per se and end-diastolic atrial or ventricular wall stress), 4) myocardial ischemia, and 5) inflammatory process. In this article, we review clinical importance of novel biomarkers referring our previous clinical investigation and other reports, especially troponin T for detection of minor myocardial damage associated with vulnerable plaque with thrombus/embolus, heart-type fatty acid -binding protein for earlier detection of myocardial damage and it's role for the rule-out triage, N-terminal pro-BNP for earlier risk stratification in cardiac emergency, and soluble CD40 ligand for earlier identification of plaque destabilization with platelet activation in non-ST-elevation acute coronary syndrome.
authors.affiliation: Department of Cardiology, Nippon Medical School.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Seino
authors.forename: Akio
authors.initials: A
authors.lastname: Ogawa
authors.forename: Teruyo
authors.initials: T
authors.lastname: Yamashita
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Fujita
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Ogata
mesh_terms: D000789:Angina, Unstable / Q000175:diagnosis* / Q000209:etiology; D015415:Biomarkers / Q000097:blood; D023201:CD40 Ligand / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D009211:Myoglobin / Q000097:blood; D020097:Natriuretic Peptide, Brain / Q000097:blood; D013577:Syndrome; D020107:Troponin T / Q000097:blood
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D009211:Myoglobin; D020107:Troponin T; D020097:Natriuretic Peptide, Brain; D023201:CD40 Ligand; D052279:Creatine Kinase, MB Form