Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systematic review.
BACKGROUND
Novel biomarkers of myocardial ischemia and inflammatory processes have the potential to improve diagnostic accuracy of acute coronary syndrome (ACS) within a shorter time interval after symptom onset.


OBJECTIVE
The objective was to review the recent literature and evaluate the evidence for use of novel biomarkers in diagnosing ACS in patients presenting with chest pain or symptoms suggestive of cardiac ischemia to the emergency department or chest pain unit.


METHODS
A literature search was performed in MEDLINE, EMBASE, Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, and NHSEED for studies from 2004 to 2010. We used the inclusion criteria: (1) human subjects, (2) peer-reviewed articles, (3) enrolled patients with ACS, acute myocardial infarction or undifferentiated signs and symptoms suggestive of ACS, and (4) English language or translated manuscripts. Two reviewers conducted a hierarchical selection and assessment using a scale developed by the International Liaison Committee on Resuscitation.


RESULTS
Out of a total 3194 citations, 58 articles evaluating 37 novel biomarkers were included for final review. Forty-one studies did not support the use of their respective biomarkers. Seventeen studies supported the use of 5 biomarkers, particularly when combined with cardiac-specific troponin: heart fatty acid-binding protein, ischemia-modified albumin, B-type natriuretic peptide, copeptin, and matrix metalloproteinase-9.


CONCLUSIONS
In patients presenting to the emergency department with chest pain or symptoms suggestive of cardiac ischemia, there is inadequate evidence to suggest the routine testing of novel biomarkers in isolation. However, several novel biomarkers have the potential to improve the sensitivity of diagnosing ACS when combined with cardiac-specific troponin.
Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Steve
S
Lin
Hiroyuki
H
Yokoyama
Valeria E
VE
Rac
Steven C
SC
Brooks
D054058:Acute Coronary Syndrome / Q000175:diagnosis; D015415:Biomarkers / Q000032:analysis* / Q000097:blood; D004636:Emergency Service, Hospital; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D006020:Glycopeptides / Q000097:blood; D006801:Humans; D020780:Matrix Metalloproteinase 9 / Q000097:blood; D017202:Myocardial Ischemia / Q000175:diagnosis*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012709:Serum Albumin; D000075462:Serum Albumin, Human
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D006020:Glycopeptides; D012709:Serum Albumin; C048197:copeptins; C561522:ischemia-modified albumin; D020097:Natriuretic Peptide, Brain; D020780:Matrix Metalloproteinase 9; D000075462:Serum Albumin, Human