Multi-Marker Approach with the Use of Biochip Cardiac Array Technology for Early Diagnosis in Patients with Acute Coronary Syndromes
Marcin Sawicki1, Grazyna Sypniewska1, Magdalena Krintus1
1Department of Laboratory Medicine, University of Nicolaus Copernicus , Bydgoszcz, Poland.
Insights
Early detection of acute coronary syndrome (ACS) is improved using a multi-marker strategy. Heart-fatty acid binding protein (H-FABP) shows high early efficacy, enhancing diagnosis alongside sensitive troponin assays.
Area of Science:
- Cardiology
- Biomarker Discovery
- Diagnostic Technologies
Background:
- Acute coronary syndrome (ACS) diagnosis is challenging, requiring rapid risk stratification.
- CK-MB mass and troponins have prolonged release patterns, complicating early chest pain origin identification.
- A multi-marker approach may improve differential diagnosis of ACS.
Purpose of the Study:
- To evaluate the efficacy of a multi-marker strategy using biochip array technology for early ACS identification.
- To compare the diagnostic performance of various cardiac biomarkers shortly after symptom onset.
Main Methods:
- 42 patients with suspected ACS were studied.
- Serum biomarkers were measured on admission (≤6 hours) and 6 hours later.
- Cardiac troponin I (cTnI) was measured by a routine assay; six cardiac markers, including heart-fatty acid binding protein (H-FABP), were assessed via biochip array.
Main Results:
- H-FABP showed high early efficacy (90.5%) in ACS detection, outperforming myoglobin and CK-MB mass.
- H-FABP sensitivity reached 100% for non-ST-elevation myocardial infarction (NSTEMI)/ST-elevation myocardial infarction (STEMI).
- Diagnostic efficacy of troponin, myoglobin, and CK-MB mass improved significantly within 12 hours, but not for unstable angina (UA) early on.
Conclusions:
- A multi-marker strategy incorporating H-FABP and sensitive troponin enhances early ACS diagnosis and decision-making.
- Biochip cardiac array technology offers a powerful tool for clinical ACS detection.
- Early risk stratification for UA remains a challenge with the current panel.
Introduction:
Diagnosis of acute coronary syndrome (ACS) is frequently a challenging task while immediate risk stratification remains crucial for the prompt implementation of appropriate therapy in this setting. The prolonged release pattern of both CK-MB mass and cardiac troponins makes it difficult to identify the origin of recent chest pain, thus a combination of early and later biomarkers might further facilitate the differential diagnosis. The study was designed to evaluate the efficacy of multi-marker approach using biochip array technology in identifying ACS shortly after the symptom onset.
Material And Methods:
The study group consisted of 42 patients suspected for ACS. Subjects were diagnosed as presenting with unstable angina (UA), non-ST-elevation myocardial infarction (NSTEMI) or ST-elevation myocardial infarction (STEMI). Biomarkers in the serum were determined twice: on admission (≤6 hours from the chest pain onset) and after next 6 hours. Cardiac troponin I was measured by routine sensitive automated assay (STAT cTnI) while other 6 cardiac markers (heart-fatty acid binding protein - H-FABP, myoglobin, glycogen phosphorylase BB, cTn I, CK-MB mass and carbonic anhydrase III) were assessed using biochip array technology.
Results:
STAT cTnI concentrations within 6 hours from the symptom onset were elevated over the 99(th) percentile for reference population in 83.3% of subjects but none reached the cut-off value for myocardial infarction. Instead, H-FABP demonstrated a very good efficacy in early detection of ACS (90.5%), better than myoglobin and CK-MB mass. Sensitivity of H-FABP calculated for NSTEMI/STEMI subjects reached 100%. The diagnostic efficacy of troponin, myoglobin and CK-MB mass assay markedly increased within 12 hours. It was only for the patients with UA that the cardiac panel was not efficient in the early stratification of risk.
Conclusions:
A multi-marker strategy with H-FABP and highly sensitive troponin included enhances the early diagnosis and decision making process in patients with ACS. A new biochip cardiac array technology may serve as a powerful tool for ACS detection in the clinical practice.
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