Do we need additional laboratory markers of ACS?

Biochemical markers are playing an im-portant role in the diagnosis of acute coro-nary syndrome (ACS). Due to their high sensitivity and absolute specificity for my-ocardial damage, cardiac troponins repre-sent the most widely used biomarkers for the diagnosis of ACS. Recently, a number of novel biomarkers have been evaluated as alternative markers that would bring add-ed value to the measurement of troponins. This manuscript gives an overview of the most commonly investigated markers in this field.

acute coronary syndrome, high sensitive troponin, copeptin

1. Joint International Society and Federation of Cardiology; World Health Organization. Special report. Nomenclature and criteria for diagnosis of ischemic heart disease. Circulation. 1979; 59:607-609. 

2. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD. The Writing Group on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction. Third universal definition of myocardial infarction. European Heart Journal. 2012; 33:2551–2567.

3. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2011; 32:2999–3054.

4. Rogic D. Laboratorijska dijagnostika hitnih stanja – pretrage uz bolesnika – srčani biljezi. In: Sertic J. Klinička kemija i molekularna dijagnostika. 1st ed. Zagreb: Medicinska naklada; 2008. p. 21-31. Croatian

5. Giannitsis E, Katus HA. Comparison of Cardiac Troponin T and Troponin I Assays – Implications of Analytical and Biochemical Dif-ferences on Clinical Performance. Clin Lab. 2004; 50:521-528.

6. Thygesen K, Alpert JS, White HD. Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction et al. Universal definition of myocardial infarction. Circulation. 2007; 116:2634-2653.

7. Meune C, Zuily S, Wahbi K, Claessens YE, Weber S, Chenevier-Gobeaux C. Combination of copeptin and high-sensitivity cardiac troponin T assay in unstable angina and non-ST-segment elevation myocardial infarction: A pilot study. Arch Cardiovasc Dis. 2011; 104:4-10.

8. Lotze U, Lemm H, Heyer A, Müller K. Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction: first experience in an emergency department of a general hospital. Vasc Health Risk Manag. 2011; 7:509–515.

9. Mueller C, Giannitsis E, Christ M, Ordonez-Llanos J, de Filippi C, McCord J et al. Multicenter Evaluation of a 0-Hour/1-Hour Algo-rithm in the Diagnosis of Myocardial Infarction With High-Sensitivity Cardiac Troponin T. Ann Emerg Med (in press)

10. Lippi G, Plebani M, Di Somma S, Monzani V, Tubaro M, Volpe M, et al. Considerations for early acute myocardial infarction rule-out for emergency department chest pain patients: the case of copeptin. Clin Chem Lab Med. 2012; 50:243–253.

11. Body R, Carley S, McDowell G et al. Rapid Exclusion of Acute Myocardial Infarction in Patients With Undetectable Troponin Using a High-Sensitivity Assay. Journal of the American College of Cardiology. 2011; 58:1332-1339.

12. Sabatine MS, Morrow DA, de Lemos JA, Gibson CM, Murphy SA, Rifai N, et al. Multimarker approach to risk stratification in non-ST elevation acute coronary syndromes: simultaneous assessment of troponin I, C-reactive protein, and B-type natriuretic peptide. Circula-tion. 2002; 105:1760-1763.

13. Bodí V, Sanchis J, Llàcer A, Fácila L, Núñez J, Pellicer M, et al. Multimarker risk strategy for predicting 1-month and 1-year major events in non-ST-elevation acute coronary syndromes. Am Heart J. 2005; 149:268-274.

14. Tello-Montoliu A, Marín F, Roldán V, Mainar L, LópezMT, Sogorb F, et al. A multimarker risk stratificationapproach to non-ST elevation acute coronary syndrome:implications of troponin T, CRP, NT pro-BNP and fibrin D-dimer levels. J Intern Med. 2007; 262:651-658.

15. Chiu A, Chan WK, Cheng SH, Leung CK, Choi CH. Troponin-I, myoglobin, and mass concentration of creatine kinase-MB in acute myocardial infarction. Q J Med. 1999; 92:711-718.

16. Apple FS, Christenson RH, Valdes R Jr, Andriak AJ, Berg A, Duh SH, et al. Simultaneous rapid measurement of whole blood myoglobin, creatine kinase MB, and cardiac troponin I by the triage cardiac panel for detection of myocardial infarction. Clin Chem. 1999; 45:199-205.

17. McMahon CG, Lamont JV, Curtin E, McConnell RI, Crockard M, Kurth MJ, et al. Diagnostic accuracy of heart-type fatty acid-binding protein for the early diagnosis of acute myocardial infarction. Am J Emerg Med. 2012; 30: 267-274.

18. Body R, McDowell R, Carley S, Wibberley C, Ferguson J, Mackway-Jones K. A FABP-ulous ‘rule out’ strategy? Heart fatty acid binding protein and troponin for rapid exclusion of acute myocardial infarction. Resuscitation. 2011; 82:1041-1046.

19. National Clinical Guideline Centre for Acute and Chronic Conditions. Chest pain of recent onset: NICE Guideline; 2011 [updated 2016 March]. Available from: http://www.nice.org uk/guidance/.

20. Diercks DB, Peacock WF 4th, Hollander JE, Singer AJ, Birkhahn R, Shapiro N, et al. Diagnostic accuracy of a point-of-care assay for acute myocardial infarction within 3 hours after presentation in early presenters to the emergency department with chest pain. Am Heart J. 2012; 163:74-80.

21. Pelsers MM, Hermens WT, Glatz JF. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta. 2005; 352:15-35.

22. Cubranic Z, Madzar Z, Matijevic S, Dvornik S, Fisic E, Tomulic V, et al. Diagnostic accuracy of heart fatty acid binding protein (H-FABP) and glycogen phosphorylase isoenzyme BB (GPBB) in diagnosis of acute myocardial infarction in patients with acute coronary syndrome. Biochemia Medica. 2012; 22:225-236.

23. Keller T, Tzikas S, Zeller T, Czyz E, Lillpopp L, Ojeda FM, et al. Copeptin Improves Early Diagnosis of Acute Myocardial Infarction. Journal of the American College of Cardiology. 2010; 55:2096-2106.

24. Reichlin T, Hochholzer W, Stelzig C, Laule K, Freidank H, Morgenthaler NG, et al. Incremental value of cocpetin for rapid rule out of acute myocardial infarction. Journal of the American College of Cardiology. 2009; 54:60-68.

25. Lotze U, Lemm H, Heyer A, Müller K. Combined determination of highly sensitive troponin T and copeptin for early exclusion of acute myocardial infarction: first experience in an emergency department of a general hospital. Vascular Health and Risk Management. 2011; 7: 509–515.

26. Meunea C, Zuily S, Wahbia K, Claessensb JE, Webera S, Chenevier-Gobeauxc C. Combination of copeptin and high-sensitivity cardiac troponin T assay in unstable angina and non-ST-segment elevation myocardial infarction: A pilot study. Archives of Cardiovascular Disease. 2011; 104:4-10.

27. EBM Viswanathan K, Hall AS, Barth JH. An Evidence-Based Approach to the Assessment of Heart-Type Fatty Acid Binding Protein in Acute Coronary Syndrome. Clin Biochem Rev. 2012; 33:3-11.

28. Inoue K, Suwa S, Ohta H, Itoh S, Maruyama S, Masuda N, et al. Heart Fatty Acid-Binding Protein Offers Similar Diagnostic Performance to High-Sensitivity Troponin T in Emergency Room Patients Presenting With Chest Pain Circulation Journal. 2011; 75:2813 – 2820.

29. Viswanathan K, Kilcullen N, Morrell C, Thistlethwaite SJ, Sivananthan MU, Hassan TB, et al. Heart-Type Fatty Acid-Binding Protein Predicts Long-Term Mortality and Re-Infarction in Consecutive Patients With Suspected Acute Coronary Syndrome Who Are Tro-ponin Negative. Journal of the American College of Cardiology. 2010; 55:2590-2598.

30. O’Donoghue M, de Lemos JA, Morrow DA, Sabina A, Murphy SA, Buros JL, et al. Prognostic Utility of Heart-Type Fatty Acid Binding Protein in Patients With Acute Coronary Syndromes. Circulation. 2006; 114:550-557.

31. Boyd, R, Dixon D, Burrows G, Cook G, Lewis, PS. Economic Evaluation of a Heart-Type Fatty Acid Binding Protein Based Protocol for Rapid Chest Pain Assessment. Academic Emergency Medicine. 2012; 19:746-747. 

32. Body R, Carley S, Burrows G, Pemberton P, Mackway-JonesJ K. Combining heart fatty acid binding protein and high sensitivity tro-ponin in the Emergency Department. Poster session presented at: GI/GU/Vascular & other emergencies; 14th International Conference on Emergency Medicine; 2012 June 27-30; Dublin, Ireland.