[Biomarkers for detection and prediction in acute coronary syndrome]

Diagnosis of patients with suggestive symptoms of acute coronary syndrome (ACS), in an emergency department, is problematic. Troponine or CKMB are the gold standard biochemical markers to diagnose the ACS, and the clinical practice guidelines of the various scientific societies recommend their use with the best available evidence. Other biomarkers such as myoglobin, hs-PCR and natriuretic peptides, support the diagnosis of ACS although its recognition in clinical practice guidelines has a lower level of evidence. New biomarkers with sufficient reliability would be necessary to anticipate the clinical presentation of the entity. There are biomarkers such as inflammatory cytokines, cellular adhesion molecules, acute-phase reactants, plaque destabilization and rupture biomarkers, markers of myocardial ischemia and stretch, that may provide earlier assessment of the overall risk of the patient and help identify future events. Possibly, its clinical use would decrease the number of consultations in the emergency department and help prevent future adverse effects. The objective of this review is to study the potential clinical utility of new biomarkers of risk stratification in patients with ACS, as well as deepen the knowledge of the pathophysiology of this syndrome.