title: Novel biochemical markers in suspected acute coronary syndrome: systematic review and critical appraisal.
abstract: BACKGROUND
  Early recognition of acute coronary syndrome (ACS) is essential. Cardiac troponins are not consistently elevated within the first hours after symptom onset.
  
  
  OBJECTIVE
  Review current guidelines recommendations regarding biomarkers in the early assessment of ACS and review the evidence for using established and specific new diagnostic biomarkers.
  
  
  METHODS
  MEDLINE and EMBASE.
  
  
  METHODS
  Articles on diagnostic accuracy of ACS biomarkers.
  
  
  METHODS
  Relevance of clinical domain, adequacy of measures of clinical utility and outcome assessment.
  
  
  RESULTS
  The 73 articles identified on early biochemical markers CK-MB, myoglobin, heart-type fatty acid binding protein (H-FABP), ischemia modified albumin (IMA), pregnancy-associated plasma protein A, glycogen phosphorylase isoenzyme BB and myeloid-related protein 8/14 often did not quantify clinical utility correctly.
  
  
  CONCLUSIONS
  IMA and H-FABP seem to be promising biomarkers in the early assessment of ACS. There is an urgent need for adequately designed diagnostic studies of (novel) ACS markers against contemporary troponin assays.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. m.s.dekker-9@umcutrecht.nl
authors.forename: Marieke S
authors.initials: MS
authors.lastname: Dekker
authors.forename: Arend
authors.initials: A
authors.lastname: Mosterd
authors.forename: Arnoud W J
authors.initials: AW
authors.lastname: van 't Hof
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D015415:Biomarkers / Q000378:metabolism*; D006801:Humans; D017410:Practice Guidelines as Topic
chemical_list: D015415:Biomarkers