Development of an optimized multimarker strategy for early risk assessment of patients with acute coronary syndromes

Choline in acute coronary syndrome: an emerging biomarker with implications for the integrated assessment of plaque vulnerability

“…Comparative studies evaluating multiple markers in a single study population and ana lysis in troponin-negative patients are scarce. The diagnostic and prognostic utility of WBCho in troponin-negative patients was proposed in the first ACS study on choline [9], and a subsequent study indicated that WBCho and NT-pro BNP remain significant predictors in multivariate logistic regression independent of troponin I, hs-CRP and PlGF, but the event rate in troponin-negative patients was low in this study [52]. In discussions on the potential value of new markers in troponin-negative patients, it is important to mention that the characteristics of this patient cohort will change substantially with the implementation of sensitive troponin tests and low troponin cut-offs in the future.…”

“…The largest is the aforementioned study by Möckel et al who also demonstrates a modest predictive value of PCho for MACE with an odds ratio of 3.3 (1.1-9.7) using a cut-off of 18.5 µmol/l [52]. However, PCho was not significant in multivariate ana lysis and WBCho was superior in CART ana lysis.…”

“…WBCho indicated high-risk unstable angina (UA) in patients without myocardial infarction (MI) with a sensitivity and specificity of 86%. In another study by the same research group, Möckel et al demonstrated in 432 unselected patients with chest pain and suspected ACS that WBCho was a strong predictor for major cardiac events (MACE) defined as cardiac death, non fatal acute myocardial infarction (AMI), UA, chronic heart failure requiring admission, urgent percutaneous coronary intervention or coronary artery bypass grafting [52]. In multivariate ana lysis, including the factors WBCho, PCho, PlGF, LP-PLA 2 , high-sensitivity C-reactive protein (hs-CRP), D-dimer, N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), cardiac troponin I (cTnI), age and sex, only NT-pro-BNP, WBCho and D-dimers were independently and significantly predictive.…”

Diagnostic markers of acute myocardial infarction

“…In a study performed by Foley et al (66), salivary levels of troponin I and CRP correlated with the serum levels in patients with myocardial injury. Additionally, levels of MMP-9 and MPO in saliva correlated with its serum levels (67). Thus, these studies suggest that saliva can be used as an alternative to serum in the diagnosis of myocardial infarction (68).…”

Identification of myocardial injury in the emergency setting

“…ACS biomarkers used in combination panels of three or more [68][69][70] may prove to be a superior approach for the early detection of MI and future risk [71]. The diagnostic performance will be determined by the choice of the component biomarkers, as in the past there have been biomarker panels that contained only tests reflecting ongoing myocardial injury (e.g., myoglobin and CK-MB).…”