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Biomarkers in acute coronary artery disease
Matthias K Freynhofer1, Miloš Tajsić, Johann Wojta
13rd Department of Medicine, Cardiology and Emergency Medicine, Wilhelminen Hospital, 1160 Vienna, Austria. matthias.freynhofer@meduniwien.ac.at
Insights
Despite advances, ischemic complications persist. This review explores cardiac troponins, copeptin, and platelets as biomarkers for diagnosing acute coronary syndrome and managing cardiovascular risk.
Area of Science:
- Cardiology
- Biomarkers
- Cardiovascular Disease Research
Background:
- Coronary artery disease remains the leading global cause of death.
- While atherothrombosis understanding has improved diagnostics and antithrombotic therapies, ischemic complications and mortality from chronic ischemic heart disease are rising.
- A significant need exists for enhanced primary prevention, rapid diagnostics, and novel antithrombotic agents.
Purpose of the Study:
- To review the role of cardiac troponins as markers of myocardial necrosis in acute coronary syndrome (ACS) diagnosis.
- To discuss copeptin as a potential biomarker for acute endogenous stress in ACS, aiding faster diagnosis and treatment.
- To explore platelets as a rediscovered biomarker for assessing individual thrombotic/bleeding risk and personalizing antiplatelet therapy.
Main Methods:
- Literature review focusing on cardiac troponins, copeptin, and platelet biomarkers in cardiovascular disease.
- Analysis of current diagnostic and therapeutic strategies for acute coronary syndrome.
- Evaluation of the potential clinical utility of novel biomarkers for risk stratification and treatment tailoring.
Main Results:
- Cardiac troponins are established markers for myocardial necrosis in ACS.
- Copeptin shows promise as a rapid biomarker for acute endogenous stress, potentially improving ACS diagnosis and outcomes.
- Platelets are recognized as crucial biomarkers for evaluating thrombotic and bleeding risks, guiding antiplatelet therapy.
Conclusions:
- Continued research into biomarkers like cardiac troponins, copeptin, and platelets is essential for improving ACS diagnosis and management.
- Personalized risk assessment using biomarkers can optimize antithrombotic and antiplatelet strategies.
- Addressing the unmet need for effective primary prevention and novel therapies is critical for reducing cardiovascular mortality.
Abstract:
Death from coronary artery disease is by far the leading cause of death worldwide. There is no doubt that a better understanding of atherothrombosis has guided development of improved diagnostic facilities as well as revascularization technologies in combination with current antithrombotic strategies that have altogether impressively reduced acute thromboembolic complications and death from cardiovascular causes within the last decades. However, the rate of ischemic complications even after optimal revascularization and medical therapy remains high. Similarly, morbidity and death associated with chronic ischemic heart disease and ischemic cardiomyopathy respectively are constantly rising. Therefore, there is still a strong need for effective primary prevention strategies, fast and accurate diagnostic procedures as well as for new and smart antithrombotic drugs. The review focuses on cardiac troponins, as relevant markers of myocardial necrosis, currently used in the diagnostic process of acute coronary syndrome. Furthermore, we will discuss the potential role of copeptin, a new marker of acute endogenous stress in acute coronary syndrome patients, as faster diagnosis might lead to faster treatment as well as improved short- and long-term outcome following acute coronary syndrome. Finally, platelets are an old, yet rediscovered biomarker for ischemic cardiovascular outcomes that might be used to estimate the individual bleeding or thrombotic risk and to tailor antiplatelet therapy.
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