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Immunohistochemical Assessment of Acute Myocardial Infarction: A Systematic Review
Gianpiero D'Antonio1, Nicola Di Fazio2, Lavinia Pellegrini1
1Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Viale Regina Elena 336, 00161 Rome, Italy.
Insights
Detecting early acute myocardial infarction (AMI) in forensic cases is challenging. Immunohistochemistry shows promise for identifying AMI markers like cardiac troponins within six hours post-event, aiding diagnosis.
Area of Science:
- Forensic Pathology
- Cardiovascular Pathology
- Immunohistochemistry
Background:
- Diagnosing acute myocardial infarction (AMI) in the early post-event period, especially in forensic autopsies, presents significant challenges due to subtle histological changes.
- Traditional methods often fail to detect AMI within the critical first six hours, necessitating advanced diagnostic techniques.
Purpose of the Study:
- To systematically review and evaluate immunohistochemical markers for the early detection of AMI in forensic medicine.
- To identify reliable biomarkers for diagnosing AMI within six hours post-event using human and animal models.
Main Methods:
- A comprehensive literature search was conducted across PubMed and Web of Science databases (1990-2023) adhering to PRISMA guidelines.
- Studies utilizing immunohistochemistry to detect early AMI markers in human autopsies and animal models within six hours were selected.
- A total of 49 markers were screened, with 37 relevant papers identified.
Main Results:
- C5b-9, cardiac troponins, dystrophin, and H-FABP demonstrated high specificity for early AMI detection.
- S100A1 and IL-15 showed potential as diagnostic markers, while JunB and connexin-43 were less reliable.
- Combinations of complementary markers may enhance diagnostic accuracy.
Conclusions:
- Immunohistochemistry offers a valuable tool for the early identification of AMI in forensic investigations.
- Further research focusing on human samples and standardized protocols is crucial for clinical implementation in forensic settings.
Abstract:
In forensic medicine, spotting signs of an acute myocardial infarction (AMI) right after it happens is still a tough call, especially in sudden-death cases. Standard histology often misses changes in those critical first hours because the tissue damage is too subtle to see. To tackle this, we reviewed research (1990-2023) from PubMed and Web of Science, following PRISMA guidelines. We focused on studies that used immunohistochemistry to identify markers of early AMI in both human autopsies and animal models, specifically in the first six hours post-event. Our selection process narrowed 418 records to 37 key papers. We screened 49 markers in total, but only a handful stood out for reliable diagnosis: C5b-9, cardiac troponins, dystrophin, and H-FABP-all showing high specificity. Markers like S100A1 and IL-15 also showed promise, whereas JunB and connexin-43 appeared less dependable. We believe immunohistochemistry can add real value in early AMI identification, especially when using combinations of markers chosen for complementary strengths. Still, to make this approach practical in forensic settings, we need more studies on human samples and agreement on standardized lab protocols.
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