Potential value for new diagnostic markers in the early recognition of acute coronary syndromes

Abstract

The diagnostic approach to acute coronary syndromes (ACS) remains one of the most difficult and controversial challenges facing emergency physicians. In recent years, cardiac troponins have emerged as the biochemical "gold standard" for diagnosis of patients with acute chest pain, enhancing our ability to recognize ACS. Early diagnosis and treatment of myocardial ischemia improve patient outcomes, but conventional markers are often nondiagnostic at the time of arrival at the emergency department. Promising new biomarkers, which appear earlier after the onset of ischemia, are being studied and integrated into clinical practice. Some are markers of myocyte necrosis, but others, including ischemia-modified albumin and natriuretic peptides, detect myocardial ischemia and myocardial dysfunction. The aim of the present article is to review the diagnostic approach to ACS, focusing on recent literature describing novel biochemical markers. If ongoing and future studies confirm their role in probability-based models risk assessment, a new era in the diagnostic approach to ACS may be dawning. RÉSUMÉLa démarche diagnostique face aux syndromes coronariens aigus (SCA) demeure l'un des défis les plus complexes et controversés auxquels sont confrontés les médecins d'urgence. Au cours des dernières années, les troponines cardiaques sont devenues la «méthode de référence» biochimique pour le diagnostic de la douleur thoracique aiguë, améliorant notre capacité d'identifier le SCA. Le diagnostic précoce et le traitement de l'ischémie myocardique améliorent le pronostic pour le patient, mais les marqueurs conventionnels sont souvent non diagnostiques au moment de l'arrivée du patient au département d'urgence. De nouveaux biomarqueurs prometteurs, qui se manifestent plus tôt après le début de l'ischémie, sont présentement à l'étude et intégrés à la pratique clinique. Certains sont des marqueurs de la nécrose myocytaire, mais d'autres, incluant l'albumine modifée par l'ischémie et les peptides niatrurétiques, détectent l'ischémie myocardique et le dysfonctionnement myocardique. Le présent article a pour but de revoir la dé-marche diagnostique face au SCA, en se concentrant sur la littérature récente décrivant les nouveaux marqueurs biochimiques. Si les études en cours et futures confirment le rôle de ces derniers quant à l'évaluation des risques à partir de modèles fondés sur la probabilité, une nouvelle ère dans la démarche diagnostique face au SCA pourrait être sur le point de voir le jour.

Diagnostic value of D-dimer measurement in patients referred to the emergency department with suspected myocardial ischemia

“…In recent years, the measurement of cardiac troponins has become recognized as the biochemical ''gold standard'' for diagnosis of patients with acute chest pain [1][2][3][4]. However, the usefulness of conventional markers of myocardial necrosis may be limited, since their values are often not yet diagnostic at the time of the patient's arrival to the Emergency Department (ED).…”

“…However, the usefulness of conventional markers of myocardial necrosis may be limited, since their values are often not yet diagnostic at the time of the patient's arrival to the Emergency Department (ED). Promising new biomarkers that appear soon after the onset of ischemia are being studied and integrated into clinical practice [3,4]. Among these, some are markers of myocyte necrosis, such as myoglobin, whereas the ischemia-modified albumin may detect myocardial ischemia prior to necrosis.…”

Ischemia modified albumin as an early biomarker in diagnosing the late stages abortus in cows

“…et al, 2009). Moreover, IMA can be present for various conditions which have a likelihood of posing a threat to the life and which can result in local or general hypoxic conditions (Lippi et al, 2006), including progressed nephritic disease, skeletal muscle ischemia, lung embolism, paralysis, acute mesenteric ischemia and intrauterine ischemia (Kotani et al, 2011, Refaai et al, 2006, Ukinc et al, 2009). …”

Ischemic heart disease in the emergency room: state of the art, innovation and research

“…19 A variety of tests have been proposed over the past decades for the diagnostic approach of IHD, either alone or in combination with troponin. 20 These mostly -but not exclusively -include inflammatory mediators or reactants (i.e. highsensitive C reactive protein, procalcitonin, cytokines and interleukins), indices of plaque instability (i.e.…”