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Biochemical Markers of Acute Coronary Syndromes

Clinical Chemistry

  1. Hassan M.E. Azzazy PhD,
  2. Robert H. Christenson PhD

Published Online: 15 SEP 2006

DOI: 10.1002/9780470027318.a0507

Encyclopedia of Analytical Chemistry

Encyclopedia of Analytical Chemistry

How to Cite

Azzazy, H. M. and Christenson, R. H. 2006. Biochemical Markers of Acute Coronary Syndromes. Encyclopedia of Analytical Chemistry. .

Author Information

  1. University of Maryland School of Medicine, Baltimore, USA

Publication History

  1. Published Online: 15 SEP 2006

Abstract

The acute coronary syndromes (ACSs) are a continuum of myocardial ischemia ranging from angina, indicating reversible tissue damage, through frank myocardial infarction (MI) with extensive tissue necrosis. The mortality from acute MI in the USA alone is 500 000 deaths per year. New predictors of cardiovascular events, that are easily measurable, are needed to improve diagnostic strategies for treating ACS patients. Cardiac markers, proteins released from the injured myocardium into the circulation, are useful for the diagnosis of MI according to the World Health Organization (WHO) criteria. Troponins I and T have emerged as sensitive, more cardiac-specific clinical indicators for MI diagnosis and for risk stratification. A new generation of biochemical markers for indicating plaque rupture, platelet reactivity, and early MI offers promise for better assessment of patient risk so that clinicians may intervene to avoid adverse outcomes. Other biochemical markers, including the acute phase reactants and markers of thrombosis, may become useful for identifying a patient's location on the ACS spectrum and consequently the risk of adverse events.

This article describes the spectrum of ACS current and future biomarkers that are closely linked to the progression of cardiac injury from ACS, and various applications of biochemical markers in assessment of reinfarction, reperfusion, perioperative MI, risk stratification, guiding therapeutic intervention, and infarct sizing. Finally, an assessment of the importance of rapid testing, different triage strategies for chest pain patients, and new trends to reduce the overall costs of patient hospitalization are discussed. The recommendations of the National Academy of Clinical Biochemistry for use of cardiac markers are also presented.