An historical approach to the diagnostic biomarkers of acute coronary syndrome

Abstract

Suspected acute myocardial infarction (AMI) is one of the leading causes of admission to the emergency departments in Western countries but also an increasing cause in many other nations. The diagnosis of AMI involves the evaluation of clinical signs and symptoms, electrocardiographic assessment, and measurement of cardiac circulating biomarkers. In the last sixty years, the use of laboratory markers has changed considerably. Early biomarkers assessment has entailed testing for total enzyme activity of aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine kinase (CK). Advances in electrophoresis allowed the identification of more cardio-specific isoenzymes of both CK and LDH, thus leading to the introduction of the CK-MB and LDH-1 activity assays. Soon thereafter, the development of immunoassays, as well as technical advances in automation, allowed the measurements of the CK-MB in mass rather than in activity and myoglobin. Currently, cardiac troponins have the highest sensitivity and specificity for myocardial necrosis and represent the biochemical gold standard for diagnosing AMI. This review provides a chronology of the major events which marked the evolution of cardiac biomarkers testing and the development of the relative assays from the first introduction of AST in the 1950s to the last high sensitivity troponin immunoassays in the 2010s.

High-sensitivity cardiac troponin testing in routine practice: economic and organizational advantages

“…Recent evidence suggests that the use of HS-cTn may guarantee better analytical performances and will enable a shift to more rapid rule out strategies (58,59). This is especially true when the decision cutoff is lower than the 99th percentile value.…”

The effect of heparin prescription before primary PCI on long-term and short-term clinical and para clinical results and the mortality of patients with acute coronary syndrome

“…In general, ACS includes unstable angina (UA), myocardial infraction with and without increasing ST part (NSTEMI). 4 Among these cases, STEMI requires more urgent intervention and early reperfusion to restore myocardial function and prevention of ischemia and myocardial necrosis. Proper reperfusion is done by thrombolysis or primary PCI which can decrease the size of infract, protect the left ventricle and improve the longterm and short-term consequences of disease.…”

Performance evaluation of a chemiluminescence microparticle immunoassay for CK‐MB

“…The name originates from the various combinations of the M (muscle) and brain (brain) isoforms. Therefore, there are three different isoenzymes: CK‐MM, CK‐BB, and CK‐MB . CK‐MM mainly exists in all kinds of muscle cells, CK‐BB mainly exists in the part of the brain cells, and CK‐MB mainly exists in the myocardial cells.…”