Potential value for new diagnostic markers in the early recognition of acute coronary syndromes.
The diagnostic approach to acute coronary syndromes (ACS) remains one of the most difficult and controversial challenges facing emergency physicians. In recent years, cardiac troponins have emerged as the biochemical "gold standard" for diagnosis of patients with acute chest pain, enhancing our ability to recognize ACS. Early diagnosis and treatment of myocardial ischemia improve patient outcomes, but conventional markers are often nondiagnostic at the time of arrival at the emergency department. Promising new biomarkers, which appear earlier after the onset of ischemia, are being studied and integrated into clinical practice. Some are markers of myocyte necrosis, but others, including ischemia-modified albumin and natriuretic peptides, detect myocardial ischemia and myocardial dysfunction. The aim of the present article is to review the diagnostic approach to ACS, focusing on recent literature describing novel biochemical markers. If ongoing and future studies confirm their role in probability-based models risk assessment, a new era in the diagnostic approach to ACS may be dawning.
Lippi
Giuseppe
G
Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy. ulippi@tin.it
Montagnana
Martina
M
Salvagno
Gian Luca
GL
Guidi
Gian Cesare
GC
D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D003402:Creatine Kinase / Q000097:blood; D006801:Humans; D017202:Myocardial Ischemia / Q000097:blood / Q000175:diagnosis*; D009211:Myoglobin / Q000097:blood; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011266:Pregnancy-Associated Plasma Protein-A / Q000032:analysis; D012709:Serum Albumin / Q000032:analysis; D014336:Troponin / Q000097:blood
D015415:Biomarkers; D009211:Myoglobin; D012709:Serum Albumin; D014336:Troponin; D020097:Natriuretic Peptide, Brain; D003402:Creatine Kinase; D011266:Pregnancy-Associated Plasma Protein-A