Cardiac biomarkers in acute coronary syndromes: a review

Early recognition is indispensable for the optimal management of Acute Coronary Syndrome (ACS); moreover, early prognostic stratification of patients with established ACS is useful to improve strategies for these patients. The paper focuses attention on troponins (I and T), the most validated biomarker for early diagnosis of ACS and on B-type natriuretic peptide (BNP) and N-terminal proB-type natriuretic peptide (NT-proBNP), the most powerful cardiac marker after troponin to be used as prognostic indicator in patients with ACS. We pay particular attention to the troponin story in ACS, including discussions about high sensitivity methods and on the most recent techniques (e.g. Point Of Care) available to shorten times from the blood sampling to the validated report [Turn around time (TAT) arm-to-report]. We report the differences between BNP and NT-proBNP, both from an analytical and a clinical point of view and discuss the use of cardiac natriuretic peptides for early recognition of cardiac insufficiency and early management of patients presenting to Emergency Departments with dyspnoea. Finally, we briefly discuss the most promising new cardiac markers actually used only in preclinical studies.