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FUTURE BIOMARKERS IN ACUTE CORONARY SYNDROME

Bertil Lindahl1,*

1Uppsala Clinical research center, Uppsala University, Uppsala, Sweden

Acute coronary syndrome (ACS) is an umbrella term for acute myocardial infarction (AMI) and unstable angina. There have been dramatic changes in the diagnosis, treatment and prognosis of ACS over the past 2-3 decades that have led to an impressive improvement in the outcome. However, ACS is still the leading cause of premature death in the western world.

Biomarkers have crucial roles in the management of ACS: for diagnosis as well as for prognosis and selection of treatment.  At present, cardiac troponins (cTn) are the biomarker of choice for diagnosis of AMI. Currently, there are no other biomarkers, which can compete, neither regarding specificity nor regarding early sensitivity for cardiomyocyte injury. However, there is still a clinical need of a biomarker able to reliably rule-in or rule-out AMI, immediately on admission. Secondly, a marker able of separating type I from type II AMI would be clinically very useful. Thirdly, a biomarker of cardiac ischemia would clinically be very useful. A number of candidate biomarkers, including microRNAs, have been suggested and will be reviewed.

The list of biomarkers associated with an adverse outcome in ACS is long, especially for mortality, but less so for future AMI. However, for most of them it has been very difficult to prove an added clinical value. Only cTn, and to some degree also B-type natriuretic peptides, is widely used in clinical practice for risk assessment. Among new markers, growth differentiation factor 15 has shown some promising results, however lacks cardiac specificity.

Cardiac troponin has been proven useful for selection of antithrombotic, antiplatelet and invasive treatment. Besides cardiac troponins, no other markers have consistently been shown to be useful for selection of specific treatments. However, since more and more treatment options become available, new biomarkers for tailoring of treatment are much needed. 

Keywords: Biomarker, Cardiovascular