Newer, more sensitive troponin assays have been introduced to rectify this weakness. Whilst the use of Troponin for diagnosing AMI and risk stratification to aid decision making has revolutionised the management of patients presenting with chest pain, the 12-hour wait for the levels to peak remains the Achilles heel of this biomarker. Troponin levels peak at 12 hours, and stay elevated for 10 days or more. However, following reperfusion therapy, the actual troponin level can be misleading due to the washout phenomenon. It is highly specific to cardiac tissue and accurately diagnoses myocardial infarction with a history of ischaemic pain or ECG changes reflecting ischaemia.Ĭardiac troponin level is dependent on infarct size, thus giving clinicians an idea of the prognosis following an infarct. Troponin is a protein released from myocytes when irreversible myocardial damage occurs. In 2000, Cardiac Troponin replaced CK-MB as the biomarker of choice for diagnosing a myocardial infarction. Two well known biomarkers in use for diagnosis of acute myocardial infarction are Creatine-Kinase-MB isoform and Cardiac Troponin. Furthermore, biomarkers also provide prognostic information about the disease, which then aids clinicians in deciding how aggressively they need to treat the disease. Here, biomarkers become important, to help us improve our diagnostic accuracy of the disease, as treatments are not without risk. Over time it has become clear that in order for such treatments to be of maximal benefit, timely diagnosis is important. Early treatment of myocardial ischaemia to prevent necrosis with treatments such as fibrinolysis, coronary artery bypass grafting and percutaneous coronary intervention have improved outcome. Myocardial necrosis following infarction is followed by heart failure, myocardial rupture or arrhythmias. Over the past 50 years, it has become clear that the cascade of thrombotic events following atherosclerotic plaque rupture causes occlusion of the coronary artery, interrupting blood supply and oxygen to myocardium thus resulting in infarction. Randomised trials are urgently needed to address this translational gap before the use of novel biomarkers becomes common practice to facilitate tailored treatment following an acute coronary event.Ĭoronary artery disease (CAD) and its end result, myocardial infarction (MI) continue to be a significant cause of mortality and morbidity in the western world. Novel biomarkers have improved prediction of outcome in acute myocardial infarction, but none have been demonstrated to alter the outcome of a particular therapy or management strategy. However, it is important to note that only troponin has been used to direct therapeutic intervention and none of the new prognostic biomarkers have been tested and proven to alter outcome of therapeutic intervention. A multimarker approach incorporating biomarkers and clinical scores will increase the prognostic accuracy. In addition to biomarkers, various well-validated scoring systems based on clinical characteristics are available to help clinicians predict mortality risk, such as the Thrombolysis In Myocardial Infarction score and Global Registry of Acute Coronary Events score. Some biomarkers such as myeloperoxidase and high-sensitivity C-reactive protein in an apparently healthy population predicts risk of coronary disease and allows clinicians to initiate early preventative treatment. Pregnancy associated plasma protein A levels following chest pain predicts risk of myocardial infarction and revascularisation. Growth differentiation factor-15 and high-sensitivity C-reactive protein predict death following an acute coronary syndrome. Similarly other biomarkers such as Mid-regional pro-Atrial Natriuretic Peptide, ST2, C-Terminal pro-endothelin 1, Mid-regional pro-Adrenomedullin and copeptin all provide incremental information in predicting death and heart failure. An elevated N-Terminal Pro-B-type Natriuretic Peptide has been well validated to predict death and heart failure following a myocardial infarction. Heart-type Fatty Acid Binding Protein and copeptin in combination with cardiac troponin help diagnose myocardial infarction or acute coronary syndrome in the early hours following symptoms. This review focuses on a variety of promising biomarkers which provide diagnostic and prognostic information. This may facilitate tailoring of appropriate therapy to high-risk patients. Biomarkers have been used to assist with timely diagnosis, while an increasing number of novel markers have been identified to predict outcome following an acute myocardial infarction or acute coronary syndrome. Timely diagnosis allows clinicians to risk stratify their patients and select appropriate treatment. Myocardial infarction causes significant mortality and morbidity.
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