Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
, 33 (5), 309-18

The Role of Cardiac Biomarkers in the Diagnosis and Management of Patients Presenting With Suspected Acute Coronary Syndrome

Affiliations
Review

The Role of Cardiac Biomarkers in the Diagnosis and Management of Patients Presenting With Suspected Acute Coronary Syndrome

Eric Christenson et al. Ann Lab Med.

Abstract

Myocardial infarction (MI) is the leading cause of death in the developed world. Biomarkers have an essential role in diagnosis, risk stratification, guiding management and clinical decision making in the setting of patients presenting with signs and symptoms of MI. Cardiac troponin (cTn) rose to prominence during the 1990s and has evolved to be the cornerstone for diagnosis of MI. The current criteria for MI diagnosis include a rise and/or fall in cTn with at least one value above the 99th percentile of the upper reference limit. Along with cTn, the natriuretic peptides B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) have an important role in determining prognosis and guiding management. As assays for cTn have been evolved that are capable of reliably detecting smaller and smaller quantities in the blood, a dilemma has emerged as to how to use this new information. Several studies have attempted to answer this question and have shown that these lower concentrations of cTn have important prognostic significance and, more importantly, that intervention in these patients leads to improved clinical outcomes. New algorithms incorporating BNP, NT-proBNP, and more sensitive cTn assays hold promise for more rapid diagnosis or rule-out of MI, allowing for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.

Keywords: BNP; Cardiac biomarkers; Cardiac troponin I; Cardiac troponin T; Management; Myocardial infarction.

Conflict of interest statement

No potential conflicts of interest relevant to this article were reported.

Figures

Fig. 1
Fig. 1
Classification of myocardial infarction based on the third universal definition of myocardial infarction. Adapted with permission from J Am Coll Cardiol 2012;60:1581-8.
Fig. 2
Fig. 2
Definition of myocardial infarction. Adapted with permission from J Am Coll Cardiol 2012;60:1581-8.
Fig. 3
Fig. 3
Implementation of a sensitive cardiac troponin I assay and risk of recurrent myocardial infarction and death in patients with suspected acute coronary syndrome. Adapted with permission from JAMA 2011;305:1210-6.
Fig. 4
Fig. 4
Utility of relative (panel A) and absolute changes (panel B) in cardiac troponin concentrations in the early diagnosis of acute myocardial infarction. Adapted with permission from Circulation 2011; 124:136-45.

Similar articles

See all similar articles

Cited by 5 articles

References

    1. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119:480–486. - PubMed
    1. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Circulation. 2007;115:e356–e375. - PubMed
    1. Thygesen K, Alpert JS, Jeffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60:1581–1598. - PubMed
    1. Thygesen K, Alpert JS, White HD Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition og Myocardial Infarction. Universal definition of myocardial infarction. J Am Coll Cardiol. 2007;50:2173–2195. - PubMed
    1. Babuin L, Jaffe AS. Troponin: the biomarker of choice for the detection of cardiac injury. CMAJ. 2005;173:1191–1202. - PMC - PubMed
Feedback