Markers of acute coronary syndrome in emergency room
V Loria1, I Dato, G L De Maria
1Institute of Cardiology, Catholic University, Rome, Italy. valentinaloriavl@libero.it
Insights
Diagnosing acute coronary syndromes (ACS) in the Emergency Department (ED) is challenging due to atypical symptoms and ECG changes. New early cardiac biomarkers are needed to improve diagnosis and risk stratification for patients with suspected ACS.
Area of Science:
- Cardiology
- Biochemistry
Background:
- Acute coronary syndromes (ACS) present a spectrum of heart conditions, necessitating prompt diagnosis and risk assessment.
- In the Emergency Department (ED), approximately 25% of patients present with ACS, often with atypical symptoms and absent electrocardiogram (ECG) changes, complicating diagnosis.
- Classic cardiac biomarkers show limited sensitivity, particularly early after symptom onset or with minimal myocardial damage.
Purpose of the Study:
- To highlight the limitations of current cardiac biomarkers in the ED setting for diagnosing ACS.
- To emphasize the need for novel, early-detecting biomarkers with high sensitivity and specificity for ACS.
- To discuss the potential of various markers reflecting different aspects of ACS pathogenesis.
Main Methods:
- Review of existing literature on cardiac biomarkers for ACS diagnosis.
- Analysis of the characteristics of an ideal ED biomarker (rapid release, high sensitivity/specificity, risk stratification).
- Categorization of potential ACS markers into groups: ischemia/necrosis, inflammation/plaque instability, and cardiac function.
Main Results:
- Current biomarkers like myoglobin, troponins, and CK-MB have suboptimal sensitivity, influenced by time, ischemia duration, and infarct size.
- Serial testing improves detection but doesn't fully address the need for early rule-out markers.
- A need exists for markers detecting ischemia without irreversible myocyte injury and enabling early ACS exclusion in the ED.
Conclusions:
- The diagnosis of ACS in the ED requires improved tools beyond traditional biomarkers.
- Development of early, sensitive, and specific biomarkers is crucial for timely and accurate patient management.
- Future research should focus on markers of ischemia, inflammation, plaque instability, and cardiac function for comprehensive ACS assessment.
Abstract:
Acute coronary syndromes (ACS) encompasses a spectrum of coronary heart diseases, ranging in severity from unstable angina to ST-elevation myocardial infarction (STEMI). Early diagnosis and risk stratification are needed in order to address correctly hospitalization and treatment. Although the diagnosis of STEMI in the presence of typical electrocardiogram (ECG) changes and symptoms is easy and does not require the use of biomarkers, cardiac biomarkers are particularly important in the Emergency Department (ED), where about 25% of patients admitted are affected by ACS but clinical presentation is often atypical and ECG alterations may be absent. The ideal marker in the ED should have rapid release, high sensitivity and specificity and risk stratifying properties. Classic cardiac biomarkers, like myoglobin, cardiac troponin T or I and creatine kinase-MB, have a poor sensitivity, dependent on the time past from the onset of symptoms to presentation, the duration of ischemia and the amount of myocardial tissue involved. Although the serial testing of these cardiac biomarkers can improve the detection of myocardial necrosis, there is still a need for the development of early markers that can reliably rule out ACS from the ED at presentation and also detect myocardial ischemia in the absence of irreversible myocyte injury. There are several markers which represent the different features of ACS pathogenesis and that can be divided into three major groups: markers of cardiac ischemia and necrosis, markers of inflammation and coronary plaque instability and marker of cardiac function.
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