Biomarkers in the prediction and management of acute coronary syndromes: current perspectives

Emanuele Gilardi, Paolo Iacomini, Davide Marsiliani, Guido De Marco, Marcello CovinoDepartment of Emergency Medicine, Catholic University of the Sacred Heart, A Gemelli Hospital, Rome, ItalyAbstract: A large branch of research has focused on the search for biomarkers for early detection of myocardial cell injuries. Most of these studies have evaluated patients presenting to the emergency department, underlining the need for an ideal biomarker for rapid recognition of acute coronary syndrome (ACS). In the recent past, diagnosis of ACS in the emergency department has been based mostly on clinical information and electrocardiographic findings, and markers of generic cell damage have been used to support clinical suspicion. Over the last few years, the role of markers has taken up increasingly more space in non-life-threatening conditions, confining the clinical examination of the patient to the mere waiting for results of blood tests after the electrocardiograph. Currently, the biomarkers most widely used for the diagnosis of ACS are cardiac troponins. Since their introduction into clinical practice, several generations of commercial cardiac troponin assays have been validated in analytical and clinical trials. Development of newer high-sensitivity assays seems to have improved the value of cardiac troponin as both a diagnostic and risk indicator. Several other biomarkers of ACS apart from cardiac troponin have been investigated, but most still require validation in further studies. Among these, pregnancy-associated plasma protein-A, ischemia-modified albumin, and heart-type fatty acid binding protein seem to be the most promising markers under investigation for their possible usefulness in the emergency department setting for early diagnosis of ACS. In conclusion, a multimarker approach could be the future of research. In this review, we highlight the old and new markers, especially the most studied and widely used in clinical practice in recent years, particularly those that can help the clinician to make a rapid and confident diagnosis of ACS.Keywords: biomarkers, acute coronary syndrome, myocardial infarction, emergency departmen