Circulating-free DNA and myocardial infarction: From diagnostic promise to clinical translation

This correspondence responds to the review by Rafiei et al. on circulating-free DNA (cfDNA) as a biomarker for early detection of myocardial infarction (MI). CfDNA shows potential for rapid diagnosis and real-time monitoring, but major barriers remain. Lack of standardized testing methods, uncertain utility in emergency care, and high costs risk delaying adoption and widening health inequities, particularly in low- and middle-income countries (LMICs). Key priorities include harmonizing laboratory protocols, developing point-of-care platforms, and integrating cfDNA into diagnostic algorithms with cardiac troponins and electrocardiograms (ECG). Research should focus on large, long-term cohorts that include diverse populations, and test multi-marker strategies combining cfDNA with microRNAs and DNA methylation profiles. Ensuring affordability and accessibility will be critical to translate cfDNA from experimental promise to routine cardiovascular practice.