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Prognostic Biomarkers in Acute Coronary Syndromes: Risk Stratification Beyond Cardiac Troponins

K M Eggers1, B Lindahl2

  • 1Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, S-751 85, Uppsala, Sweden. kai.eggers@ucr.uu.se.

Current Cardiology Reports
|March 19, 2017
PubMed

Insights

Cardiac troponin (cTn) is vital for acute coronary syndrome (ACS) outcomes, but not absolute. Biomarkers like natriuretic peptides (NPs) and GDF-15 offer added prognostic value beyond cTn in ACS risk prediction.

Area of Science:

  • Cardiology
  • Biomarker Discovery
  • Acute Coronary Syndromes

Background:

  • Cardiac troponin (cTn) is a key prognostic marker in acute coronary syndrome (ACS).
  • The prognostic value of cTn alone is limited, necessitating exploration of additional biomarkers.
  • Established biomarkers for left-ventricular dysfunction, hemodynamic stress, inflammation, and renal dysfunction are being investigated for enhanced risk prediction in ACS.

Purpose of the Study:

  • To review the utility of established biomarkers for risk prediction beyond cardiac troponin (cTn) in patients with acute coronary syndrome (ACS).
  • To evaluate the additive prognostic value of biomarkers reflecting left-ventricular dysfunction, hemodynamic stress, inflammation, and renal dysfunction in ACS.
  • To assess the current evidence on biomarkers that may improve risk stratification in ACS.

Main Methods:

  • Mini-review of existing literature.
  • Summary of evidence on established biomarkers for risk prediction in ACS.
  • Analysis of prognostic value of biomarkers beyond cTn.

Main Results:

  • Few biomarkers consistently show additive prognostic value to cTn levels.
  • B-type natriuretic peptides (NPs) and growth-differentiation factor-15 (GDF-15) are the most promising biomarkers.
  • The incremental prognostic value of NPs and GDF-15 to high-sensitivity cTn assays requires further definition.
  • Uncertainties remain regarding the role of these biomarkers in guiding treatment decisions in contemporary ACS management.

Conclusions:

  • NPs and GDF-15 offer the strongest prognostic increment to cTn levels in ACS.
  • The clinical utility of NPs and GDF-15 for guiding treatment decisions in current ACS settings needs further investigation.
  • Further research is required to fully define the role of these biomarkers in optimizing ACS patient management.
Abstract

Keywords:
Acute coronary syndromeBiomarkersRisk prediction

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