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Biochemical markers of the acute coronary syndromes
1Department of Pathology, University of Maryland School of Medicine, Baltimore 21201, USA. rchriste@umaryland.edu
Insights
Biochemical markers like troponin T and I are crucial for diagnosing myocardial infarction (MI) and assessing acute coronary syndrome (ACS) risk. These markers, alongside others, aid in monitoring treatment and patient outcomes.
Area of Science:
- Cardiology
- Biochemistry
- Clinical Diagnostics
Background:
- Acute coronary syndromes (ACS) encompass a spectrum of myocardial ischemia, from angina to myocardial infarction (MI).
- Traditional ACS assessment relied on WHO criteria, including symptoms, ECG, and biochemical markers like creatine kinase-MB (CK-MB), which lacks cardiac specificity.
- Emerging cardiac-specific biomarkers offer improved diagnostic and prognostic capabilities.
Purpose of the Study:
- To review the evolution and role of biochemical markers in diagnosing and managing acute coronary syndromes.
- To highlight the significance of cardiac troponins (T and I) in MI detection and risk stratification.
- To explore the potential of novel biomarkers reflecting plaque instability, platelet activation, ischemia, and thrombosis.
Main Methods:
- Review of historical and current biochemical markers used in ACS.
- Evaluation of cardiac troponins as sensitive indicators for MI and risk stratification.
- Discussion of emerging markers for plaque disruption, platelet activity, ischemia, and coagulation.
Main Results:
- Cardiac troponin T and I are superior to CK-MB for MI diagnosis and risk stratification in ACS.
- Novel markers like C-reactive protein, serum amyloid A, P-selectin, glycogen phosphorylase-BB, and soluble fibrin show promise.
- Combined use of markers (e.g., CK-MB, myoglobin) with clinical data aids reperfusion monitoring.
Conclusions:
- Biochemical markers are indispensable for MI diagnosis, risk assessment, and reperfusion monitoring in ACS.
- Cardiac troponins represent a significant advancement in ACS management.
- Future research will likely integrate a broader panel of biomarkers for comprehensive patient evaluation.
Abstract:
The acute coronary syndromes represent a continuum of myocardial ischemia ranging from angina, reversible tissue injury --> unstable angina, frequently associated with minor myocardial damage --> myocardial infarction and extensive tissue necrosis. Historically, coronary artery disease assessment has been mainly binary, using WHO criteria of symptoms, electrocardiography, and biochemical markers. The creatine kinase-MB isoenzyme (CK-MB) has been a benchmark for markers, but it is not specific for myocardium. Cardiac-specific isoforms of troponin T and I have emerged as sensitive myocardial infarction (MI) indicators and, importantly, for risk stratification of acute coronary syndrome patients. In addition to markers of myocardial cell necrosis, markers of plaque disruption (C-reactive protein and serum amyloid A), "angry" platelets (P-selectin), ischemia (glycogen phosphorylase-BB isoenzyme), and the procoagulant state and thrombosis (soluble fibrin) have potential use. Also, CK-MB and myoglobin have been combined with clinical indicators for monitoring reperfusion after thrombolytic therapy. Biochemical markers will continue to be an important clinical adjunct for MI diagnosis, risk assessment, and reperfusion monitoring in the future.