NEW IN THE USE OF BIOMARKERS IN ACUTE CORONARY SYNDROME
Keywords:
acute coronary syndrome, biomarkers, myoglobin, CPK-MB, troponin, CRP, matrix metalloproteinases
Abstract
In the absence of ischemic changes on ECG should be assessed biomarkers to exclude myocardial infarction (MI), and further diagnostic testing to exclude ischemia in patients without MI. Although for the diagnosis of MI is routinely used by a number of biomarkers, only three of them – myoglobin, CPK-MB (CK-MB) and troponin – the most frequently used in cardiology practice. In addition, these markers are also used to identify patients at risk of recurrent cardiac events. Among the many new biomarkers in acute coronary syndrome, according to the results of individual studies, high expectations on lipoprotein associated phospholipase A2 – a marker of local inflammation in the plaques, high-sensitivity troponin, allowing in the first 2:00 to diagnose MI. Perspective may be a new marker of myocyte injury – cardiac protein that binds free fatty acids (H-FABP), matrix metalloproteinases-9, myeloperoxidase. However, despite the diversity of the constantly growing number of new biomarkers that reflect the molecular mechanisms of atherogenesis, from its initiation and ending of myocardial necrosis, to date only 3 of them – troponins, BNP and CRP, have found practical application in clinical cardiology, entered the international recommendations as diagnostic and prognostic markers in treating ACS. At the same time, only troponin is the only biomarkers used for diagnosis, prognosis and choice of tactics of treatment of patients with ACS.
Downloads
Download data is not yet available.
References
1. Ability of myoglobin to predict mortality in patients admitted for exclusion of myocardial infarction / M.C. Kontos, R. Garg, P. Anderson [et al.] // Am.J.Emerg.Med. – 2007. – Vol. 25. – P. 873–879.
2. Roberts R. An improved basis for enzymatic estimation of infarct size / R. Roberts, P.D. Henry, B.E. So-bel //Circulation – 1975. – Vol. 52. – P. 743–754.
3. Assotiation between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without ST-elevation / J.H. Alexander, R.A. Sparapani, K.W. Mahaffey [et al.] // JAMA. – 2000. – Vol. 283. – P. 347–353.
4. The prognostic significance of serial myoglobin, troponon I, and creatine kinase-MB measurements in patients evaluated in emergency department for acute coronary syndrome / McCord J., R.M. Nowak, M.P. Hudson [et al.] // Ann.Emerg.Med. – 2003. – Vol. 43. – P. 343–350.
5. The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes. Result from the TIMI 11B and TACTICS-TIMI 18 studies / J.A. De Lemos, D.A. Morrow, C.M. Gibson [et al.] //J.Am.Coll.Cardiol. – 2002. – Vol. 40. – P. 238–244.
6. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes / J.A. deLemos, D.A. Morrow, J.H. Bentley [et al.] // N.Engl.J.Med. – 2001. – Vol. 345. – P. 1014–1021.
7. Elevated creatine kinase-MB with normal creatine kinase predicts worse outcomes in patients with nor-mal outcomes in patients with acute coronary syndromes: results from 4 large clinical trials / J.M. Galla, K.W. Mahaffey, S.K. Sapp [et al.] // Am.Heart J. – 2006. – Vol. 151. – P. 16–21.
8. Antman E.M. Decision making with cardiac troponin tests / E.M. Antman //N.Engl.J.Med. – 2002. – Vol. 346. – P. 2079–2082.
9. Serial analyses of N-terminal pro-B-type natriuretic peptidein patients with non-ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularization during the stability in Coronary artery disease (FRISC)-II substudy / B. Lindahl, J. Lindback, T. Jernberg [et al.]//J.AmColl.Cardiol. – 2005. – Vol. 45. – P. 533–541.
10. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary disease. FRISC substudy group. Fragmin during Instability in Coronary artery disease / B. Lindahl, H. Toss, A. Siegbahn [et al.] // N.Engl.J.Med. – 2000. – Vol. 343. – P. 1139–1147.
11. Cardiac troponin T levels for risc stratification in acyte myocardial ischemia. GUSTO IIA investigators / E.M. Ohman, P.W. Armstrong, R.H. Christenson [et al.] //N.Engl.J.Med. – 1996. – Vol. 335. – P. 1333–1341.
12. Elevated cardiac troponin levels predict the risc of adverce outcome in patients with acute coronary syn-dromes / F. Ottani, M. Galvani, F.A. Nicolini [et al.] //Am.Heart.J. – 2000. – Vol. 140. – P. 917–927.
13. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction / A.M. Rich-ards, M.G. Nicholls, E.A. Espiner [et al.] //Circulation. – 2003. – Vol. 107. – P. 2786–2792.
14. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utiliza-tion of Strategies To open occluded arteries (GUSTO) – IV substudy / S.K. James, B. Lindahl, A. Siegbahn [et al.] //Circulation. – 2003. – Vol. 108. – P. 275–281.
15. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utiliza-tion of Strategies To Open occluded arteries (GUSTO) IV-substudy / S.K. James, B. Lindahl, A. Siegbahn [et al.] //Circulation. – 2003. – Vol. 108. – P. 275–281.
16. Profile of plasma N – terminal proBNP following acute myocardial infarction ; correlation with left ven-tricular systolic dysfunction / S. Talwar, I.B. Squire, P.F. Downie [et al.] // Eur . Heart J. – 2000. – Vol. 21. – P .1514–1521.
17. Plasma brain natriuretuc peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide / T. Omland, A. Aakvaag, V.V. Bonargee [et al.] //Circulation. – 1996. – Vol. 93. – P. 1963–1969.
18. Prognostic value of N-terminal pro-atrial and pro-brain natriuretic peptide in patients with acute coronary syndromes / T. Omland, J.A. de Lemos, D.A. Morrow [et al.] //Am.J.Cardiol. – 2002. – Vol. 89. – P. 463–465.
19. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes / T. Omland, A. Persson, Ng L [et al.] //Circulation. – 2002. – Vol. 106. – P. 2913–2918.
20. Evaluation of B-type natriuretic peptide for risc assessment in unstable angina/non-ST-elevation my-odcardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI-18 / D.A. Morrow, J.A. deLemos, M.S. Sabatine [et al.] //J.Am.Coll.Cardiol. – 2003. – Vol. 41. – P. 1264–1272.
21. Prognostic value of serial B-type natriuretic peptide testing during follow-up of patients with unstable coronary artery disease / D.A. Morrow, J.A. deLemos, M.A. Blazing [et al.] //JAMA. – 2005. – Vol. 294. – P. 2866–2871.
22. Serial analyses of N-terminal pro-B-type natriuretic peptidein patients with non-ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularization during the stability in Coronary artery disease (FRISC)-II substudy / B. Lindahl, J. Lindback, T.Jernberg [et al.] //J.AmColl.Cardiol. – 2005. – Vol. 45. – P. 533–541.
23. Willerson J.T. Inflammation as a cardiovascular risk factor / J.T. Willerson, P.M. Ridker //Circulation. – 2004. – Vol. 109. – P. 110–112
24. The prognostic value of C-reactive protein and serum amyloid in severe unstable angina / G.Liuzzo, L.M. Biasucci, J.R. Gallimore [et al.] //N.Engl.J.Med. – 1994. – Vol. 331. – P. 417–424.
25. Inflammation and long-term mortality after non-ST-elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consequtive patients / C. Mueller, H.J. Buettner, J.M. Hodgson [et al.] //Circulation. – 2002. – Vol. 105. – P. 1412–1415.
26. C-reactive protein is a potent predictor of mortality independently of an in combination with troponin T in acute coronary syndromes: a TIMI IIA substudy trombolysis in myocardial infarction / D.A. Morrow, N. Rifai, E.M. Antman [et al.] //J.Am.Coll.Cardiol. – 1998. – Vol. 31. – P. 1460–1465,
27. Troponin and C-reactive protein have different relations to subsequent mortality and myocardial infarc-tion after acute coronary syndrome: a GUSTO-IV substudy / S.K. James, P. Armstrong, E. Barnatan [et al.] //J.Am.Coll.Cardiol. – 2003. – Vol. 41. – P. 916–924.
28. Elevated levels of C-reactive protein at discharge in patients with unstable angina predict recurrent insta-bility / L.M. Biasucci, G. Liuzzo, R.L. Grillo [et al.] // Circulation. – 1999. – Vol. 99. – P. 855–860.
29. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary disease. FRISC substudy group. Fragmin during Instability in Coronary artery disease / B. Lindahl, H. Toss, A. Siegbahn [et al.]//N.Engl.J.Med. – 2000. – Vol. 343. – P. 1139–1147.
30. Garza C.A. Association Between Lipoprotein-Associated Phospho-lipase A2 and Cardiovascular Dis-ease: / C.A. Garza, V.M. Montori, J.P. McConnell // A Systematic Review. Mayo Clin. Proc., February 1. – 2007. –Vol. 82(2). – P. 159–165.
31. Myeloperoxidase: A Useful Biomarker for Cardiovascular Disease Risk Stratification? / R. K. Schindhelm, L.P. van der Zwan, T. Teerlink [et al.] // Clin Chem. – 2009. – Vol. 55. – P. 1462–1470.
32. Аnd for the EMMACE-2 Investigators. Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Tro-ponin Values. J. Am / N. Kilcullen, K. Viswanathan, R. Das [et al.] // Coll. Cardiol. – 2007. – Vol. 50(21). – P. 2061–2067
33. Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I. / M. Bonaca, B. Scirica, M. Sabatine [et al.] // J Am Coll Cardiol. – 2010. – Vol. 55. – P. 2118–2124.
2. Roberts R. An improved basis for enzymatic estimation of infarct size / R. Roberts, P.D. Henry, B.E. So-bel //Circulation – 1975. – Vol. 52. – P. 743–754.
3. Assotiation between minor elevations of creatine kinase-MB level and mortality in patients with acute coronary syndromes without ST-elevation / J.H. Alexander, R.A. Sparapani, K.W. Mahaffey [et al.] // JAMA. – 2000. – Vol. 283. – P. 347–353.
4. The prognostic significance of serial myoglobin, troponon I, and creatine kinase-MB measurements in patients evaluated in emergency department for acute coronary syndrome / McCord J., R.M. Nowak, M.P. Hudson [et al.] // Ann.Emerg.Med. – 2003. – Vol. 43. – P. 343–350.
5. The prognostic value of serum myoglobin in patients with non-ST-segment elevation acute coronary syndromes. Result from the TIMI 11B and TACTICS-TIMI 18 studies / J.A. De Lemos, D.A. Morrow, C.M. Gibson [et al.] //J.Am.Coll.Cardiol. – 2002. – Vol. 40. – P. 238–244.
6. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes / J.A. deLemos, D.A. Morrow, J.H. Bentley [et al.] // N.Engl.J.Med. – 2001. – Vol. 345. – P. 1014–1021.
7. Elevated creatine kinase-MB with normal creatine kinase predicts worse outcomes in patients with nor-mal outcomes in patients with acute coronary syndromes: results from 4 large clinical trials / J.M. Galla, K.W. Mahaffey, S.K. Sapp [et al.] // Am.Heart J. – 2006. – Vol. 151. – P. 16–21.
8. Antman E.M. Decision making with cardiac troponin tests / E.M. Antman //N.Engl.J.Med. – 2002. – Vol. 346. – P. 2079–2082.
9. Serial analyses of N-terminal pro-B-type natriuretic peptidein patients with non-ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularization during the stability in Coronary artery disease (FRISC)-II substudy / B. Lindahl, J. Lindback, T. Jernberg [et al.]//J.AmColl.Cardiol. – 2005. – Vol. 45. – P. 533–541.
10. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary disease. FRISC substudy group. Fragmin during Instability in Coronary artery disease / B. Lindahl, H. Toss, A. Siegbahn [et al.] // N.Engl.J.Med. – 2000. – Vol. 343. – P. 1139–1147.
11. Cardiac troponin T levels for risc stratification in acyte myocardial ischemia. GUSTO IIA investigators / E.M. Ohman, P.W. Armstrong, R.H. Christenson [et al.] //N.Engl.J.Med. – 1996. – Vol. 335. – P. 1333–1341.
12. Elevated cardiac troponin levels predict the risc of adverce outcome in patients with acute coronary syn-dromes / F. Ottani, M. Galvani, F.A. Nicolini [et al.] //Am.Heart.J. – 2000. – Vol. 140. – P. 917–927.
13. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction / A.M. Rich-ards, M.G. Nicholls, E.A. Espiner [et al.] //Circulation. – 2003. – Vol. 107. – P. 2786–2792.
14. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utiliza-tion of Strategies To open occluded arteries (GUSTO) – IV substudy / S.K. James, B. Lindahl, A. Siegbahn [et al.] //Circulation. – 2003. – Vol. 108. – P. 275–281.
15. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utiliza-tion of Strategies To Open occluded arteries (GUSTO) IV-substudy / S.K. James, B. Lindahl, A. Siegbahn [et al.] //Circulation. – 2003. – Vol. 108. – P. 275–281.
16. Profile of plasma N – terminal proBNP following acute myocardial infarction ; correlation with left ven-tricular systolic dysfunction / S. Talwar, I.B. Squire, P.F. Downie [et al.] // Eur . Heart J. – 2000. – Vol. 21. – P .1514–1521.
17. Plasma brain natriuretuc peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide / T. Omland, A. Aakvaag, V.V. Bonargee [et al.] //Circulation. – 1996. – Vol. 93. – P. 1963–1969.
18. Prognostic value of N-terminal pro-atrial and pro-brain natriuretic peptide in patients with acute coronary syndromes / T. Omland, J.A. de Lemos, D.A. Morrow [et al.] //Am.J.Cardiol. – 2002. – Vol. 89. – P. 463–465.
19. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes / T. Omland, A. Persson, Ng L [et al.] //Circulation. – 2002. – Vol. 106. – P. 2913–2918.
20. Evaluation of B-type natriuretic peptide for risc assessment in unstable angina/non-ST-elevation my-odcardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI-18 / D.A. Morrow, J.A. deLemos, M.S. Sabatine [et al.] //J.Am.Coll.Cardiol. – 2003. – Vol. 41. – P. 1264–1272.
21. Prognostic value of serial B-type natriuretic peptide testing during follow-up of patients with unstable coronary artery disease / D.A. Morrow, J.A. deLemos, M.A. Blazing [et al.] //JAMA. – 2005. – Vol. 294. – P. 2866–2871.
22. Serial analyses of N-terminal pro-B-type natriuretic peptidein patients with non-ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularization during the stability in Coronary artery disease (FRISC)-II substudy / B. Lindahl, J. Lindback, T.Jernberg [et al.] //J.AmColl.Cardiol. – 2005. – Vol. 45. – P. 533–541.
23. Willerson J.T. Inflammation as a cardiovascular risk factor / J.T. Willerson, P.M. Ridker //Circulation. – 2004. – Vol. 109. – P. 110–112
24. The prognostic value of C-reactive protein and serum amyloid in severe unstable angina / G.Liuzzo, L.M. Biasucci, J.R. Gallimore [et al.] //N.Engl.J.Med. – 1994. – Vol. 331. – P. 417–424.
25. Inflammation and long-term mortality after non-ST-elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consequtive patients / C. Mueller, H.J. Buettner, J.M. Hodgson [et al.] //Circulation. – 2002. – Vol. 105. – P. 1412–1415.
26. C-reactive protein is a potent predictor of mortality independently of an in combination with troponin T in acute coronary syndromes: a TIMI IIA substudy trombolysis in myocardial infarction / D.A. Morrow, N. Rifai, E.M. Antman [et al.] //J.Am.Coll.Cardiol. – 1998. – Vol. 31. – P. 1460–1465,
27. Troponin and C-reactive protein have different relations to subsequent mortality and myocardial infarc-tion after acute coronary syndrome: a GUSTO-IV substudy / S.K. James, P. Armstrong, E. Barnatan [et al.] //J.Am.Coll.Cardiol. – 2003. – Vol. 41. – P. 916–924.
28. Elevated levels of C-reactive protein at discharge in patients with unstable angina predict recurrent insta-bility / L.M. Biasucci, G. Liuzzo, R.L. Grillo [et al.] // Circulation. – 1999. – Vol. 99. – P. 855–860.
29. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary disease. FRISC substudy group. Fragmin during Instability in Coronary artery disease / B. Lindahl, H. Toss, A. Siegbahn [et al.]//N.Engl.J.Med. – 2000. – Vol. 343. – P. 1139–1147.
30. Garza C.A. Association Between Lipoprotein-Associated Phospho-lipase A2 and Cardiovascular Dis-ease: / C.A. Garza, V.M. Montori, J.P. McConnell // A Systematic Review. Mayo Clin. Proc., February 1. – 2007. –Vol. 82(2). – P. 159–165.
31. Myeloperoxidase: A Useful Biomarker for Cardiovascular Disease Risk Stratification? / R. K. Schindhelm, L.P. van der Zwan, T. Teerlink [et al.] // Clin Chem. – 2009. – Vol. 55. – P. 1462–1470.
32. Аnd for the EMMACE-2 Investigators. Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality After Acute Coronary Syndrome and Identifies High-Risk Patients Across the Range of Tro-ponin Values. J. Am / N. Kilcullen, K. Viswanathan, R. Das [et al.] // Coll. Cardiol. – 2007. – Vol. 50(21). – P. 2061–2067
33. Prospective Evaluation of the Prognostic Implications of Improved Assay Performance With a Sensitive Assay for Cardiac Troponin I. / M. Bonaca, B. Scirica, M. Sabatine [et al.] // J Am Coll Cardiol. – 2010. – Vol. 55. – P. 2118–2124.
How to Cite
Petyunina, O., Kopitsa, N., & Degtyareva, O. (1). NEW IN THE USE OF BIOMARKERS IN ACUTE CORONARY SYNDROME. The Journal of V. N. Karazin Kharkiv National University, Series "Medicine", (19), 82-88. Retrieved from https://periodicals.karazin.ua/medicine/article/view/6944
Issue
Section
Reviews
The Journal of V. N. Karazin Kharkiv National University, series Medicine has following copyright terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work’s authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal’s published version of the work, with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
